Provider Demographics
NPI:1083126742
Name:WILLIAM A. TISDALL, M.D., P.A.
Entity Type:Organization
Organization Name:WILLIAM A. TISDALL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALEC
Authorized Official - Last Name:TISDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-571-0400
Mailing Address - Street 1:1919 ROGERS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4774
Mailing Address - Country:US
Mailing Address - Phone:210-541-0700
Mailing Address - Fax:972-438-6585
Practice Address - Street 1:5700 SCHERTZ PKWY STE 130
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1496
Practice Address - Country:US
Practice Address - Phone:210-541-0700
Practice Address - Fax:210-541-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217091201Medicaid