Provider Demographics
NPI:1487844296
Name:TILTON, DOUGLAS M (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:TILTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:36000 DARNALL LOOP, BOX 48
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:FT. HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-288-8300
Mailing Address - Fax:254-288-8924
Practice Address - Street 1:36000 DARNALL LOOP, BOX 48
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:FT. HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8300
Practice Address - Fax:254-288-8924
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01055369A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology