Provider Demographics
NPI:1174829303
Name:TENNISON, JOHN TILMON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TILMON
Last Name:TENNISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4903 BETTY LOU DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4903
Mailing Address - Country:US
Mailing Address - Phone:210-884-0990
Mailing Address - Fax:
Practice Address - Street 1:4903 BETTY LOU DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4903
Practice Address - Country:US
Practice Address - Phone:210-884-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-05
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK79192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry