Provider Demographics
NPI:1386023968
Name:TIDWELL, ELIZABETH ANN HEEB (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN HEEB
Last Name:TIDWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MEDICAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5207
Mailing Address - Country:US
Mailing Address - Phone:903-757-6042
Mailing Address - Fax:903-232-6060
Practice Address - Street 1:802 MEDICAL DR STE 100
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5207
Practice Address - Country:US
Practice Address - Phone:903-757-6042
Practice Address - Fax:903-232-6060
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1001207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX398365201Medicaid