Provider Demographics
NPI:1598085243
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:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALEC
Authorized Official - Last Name:TISDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-541-0700
Mailing Address - Street 1:1919 ROGERS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4614
Mailing Address - Country:US
Mailing Address - Phone:210-541-0700
Mailing Address - Fax:210-514-6868
Practice Address - Street 1:1919 ROGERS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4614
Practice Address - Country:US
Practice Address - Phone:210-541-0700
Practice Address - Fax:210-514-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217091201Medicaid
TX0039TQOtherBLUE CROSS
TXTXB107741Medicare PIN