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General NPI Number Information
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NPI Number | 1952370975
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Entity Type | Organization
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Legal Business Name | THERON C TILGNER D O LLC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 387 LAKE HAVASU AVE S STE 101
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-9306
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Country | US
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Telephone | 928-854-3333
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Fax | 928-854-3335
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Provider Business Mailing Address
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Address Line | 387 LAKE HAVASU AVE S STE 101
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-9306
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Country | US
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Telephone | 928-854-3333
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Fax | 928-854-3335
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Authorized Official
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Title or Position | PRESIDENT
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Name | THERON C TILGNER
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Credential | D.O.
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Telephone | 928-854-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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