Provider Demographics
NPI:1356305684
Name:ALDANA, TIRSO J (MD)
Entity Type:Individual
Prefix:DR
First Name:TIRSO
Middle Name:J
Last Name:ALDANA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 4028
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-4028
Mailing Address - Country:US
Mailing Address - Phone:573-718-3141
Mailing Address - Fax:573-776-1011
Practice Address - Street 1:3100 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1573
Practice Address - Country:US
Practice Address - Phone:573-776-9290
Practice Address - Fax:573-776-2379
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2016-09-30
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Provider Licenses
StateLicense IDTaxonomies
MO118197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H06808Medicare UPIN