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NPI Code Detail

MEDICARE: DR. TIRSO J ALDANA M.D.

MEDICARE: DR. TIRSO J ALDANA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician118197MO

General Provider Information

NPI Number : 1356305684
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIRSO J ALDANA M.D.
Provider Business Mailing Address
First Line : PO BOX 4028
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63902-4028
Country : US
Telephone Number : 573-718-3141
Fax Number : 573-776-1011
Provider Business Practice Location Address
First Line : 3100 OAK GROVE RD
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-1573
Country : US
Telephone Number : 573-776-9290
Fax Number : 573-776-2379
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2006
Last Update Date : 09/30/2016

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