Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 4783 | SD |
Y | 207RG0100X | Gastroenterologist | 60656 | AZ |
NPI | 1043256936 |
---|---|
Provider Name | Loyal G Tillotson |
First Address | Tucson, AZ 85724-5028 |
Second Address | Tucson, AZ 85724-5462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 03/09/2020 |