Provider Demographics
NPI:1235457482
Name:TILLMAN, DAVID ARNOLD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ARNOLD
Last Name:TILLMAN
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 1:1585 S OCEAN LN
Mailing Address - Street 2:#280
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3335
Mailing Address - Country:US
Mailing Address - Phone:954-900-3903
Mailing Address - Fax:
Practice Address - Street 1:1585 S OCEAN LN
Practice Address - Street 2:#280
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3335
Practice Address - Country:US
Practice Address - Phone:954-900-3903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77148208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice