Provider Demographics
NPI:1427502186
Name:TIDMARSH, GEORGE FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:FRANCIS
Last Name:TIDMARSH
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 1:10182 TELESIS CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4760
Mailing Address - Country:US
Mailing Address - Phone:650-208-3191
Mailing Address - Fax:
Practice Address - Street 1:10182 TELESIS CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4760
Practice Address - Country:US
Practice Address - Phone:650-208-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG685892080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine