Provider Demographics
NPI:1588634455
Name:JOSIAH B TILTON MD PA
Entity Type:Organization
Organization Name:JOSIAH B TILTON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:TILTON
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:432-699-0306
Mailing Address - Street 1:PO BOX 4157
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-4157
Mailing Address - Country:US
Mailing Address - Phone:432-699-0306
Mailing Address - Fax:432-520-2181
Practice Address - Street 1:2706 W CUTHBERT AVE
Practice Address - Street 2:BLDG B SUITE 100
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3885
Practice Address - Country:US
Practice Address - Phone:432-699-0306
Practice Address - Fax:432-520-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6364207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00068TMedicare ID - Type Unspecified