Provider Demographics
NPI:1679542450
Name:TIRADO, EMILIO (M D)
Entity type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:
Last Name:TIRADO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2110 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560
Mailing Address - Country:US
Mailing Address - Phone:870-269-7610
Mailing Address - Fax:870-269-5630
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:S 808
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-664-2174
Practice Address - Fax:501-664-4236
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARN5625208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD17141Medicare UPIN