Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Justin Alan Tidwell, DPM

Individual provider Foot & Ankle Surgery Podiatrist · NPI 1710908892

Justin Alan Tidwell, DPM is a Podiatry in Portland, Oregon. Qualified in 2003, 23 years ago. Practices with Legacy Clinics LLC, a 718-clinician group and accepts Medicare assignment. Licensed in Oregon and Washington.

Years since qualifying
23
Licensed in
OR, WA
In the registry since
2006
Specialties on file
2
What do these letters mean?
DPM — Doctor of Podiatric Medicine
A foot and ankle physician and surgeon.

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Practice location Address checks out

501 N Graham St Ste 415
Portland, OR 97227-1654
Phone: (503) 413-2005
Fax: (503) 413-3699
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Foot & Ankle Surgery Podiatrist (primary) Taxonomy 213ES0103X · Licence DP00373 (OR)
Foot & Ankle Surgery Podiatrist Taxonomy 213ES0103X · Licence PO00000806 (WA)

Record details

NPI number1710908892
Entity typeIndividual (Type 1)
GenderMale
Credentials DPM
Sole proprietorYes
NPI enumeratedJuly 22, 2006
Last updated in NPPESJuly 8, 2007

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPODIATRY
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice Legacy Clinics Llc — 718 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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