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Cheryl C. Tidball Do Pc
General Practice Physician in Gresham, Oregon
NPI 1578776670

Cheryl C. Tidball Do Pc is a General Practice Physician based in Gresham, OR. Cheryl C. Tidball Do Pc practices in Gresham, OR. The NPI Number for Cheryl C. Tidball Do Pc is 1578776670 and holds a License No. DO19432 (Oregon).

The current practice location address for Cheryl C. Tidball Do Pc is 1217 Ne Burnside Rd, Gresham, OR and can be reached out via phone at 503-489-0663 and via fax at 503-666-5644.

Location: 1217 Ne Burnside Rd, Gresham, OR, 97030-6722
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1578776670
Provider Name
Cheryl C. Tidball Do Pc
Credential
Provider Entity Type
Organization
Address
1217 Ne Burnside Rd, Gresham, OR, 97030-6722
Phone Number
503-489-0663
Fax Number
503-666-5644
Provider Enumeration Date
05/07/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
203778 05 OR
institution
Provider Business Practice Location Address Details
Address
1217 Ne Burnside Rd
City
Gresham
State
Oregon
Zip
97030-6722
Phone Number
503-489-0663
Fax Number
503-666-5644
person
Provider Business Mailing Address Details
Address
1217 Ne Burnside Rd
City
Gresham
State
Oregon
Zip
97030-6722
Phone Number
503-489-0663
Fax Number
503-666-5644
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
DO19432 (Oregon)
Definition
Definition to come...
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