Provider Demographics
NPI:1790203461
Name:TISDALE, RONALD COURY (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:COURY
Last Name:TISDALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RONNIE
Other - Middle Name:
Other - Last Name:TISDALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:625 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1900
Mailing Address - Country:US
Mailing Address - Phone:650-387-2272
Mailing Address - Fax:
Practice Address - Street 1:1023 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6750
Practice Address - Country:US
Practice Address - Phone:650-387-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 390200000X, 251K00000X, 261QE0002X, 261QU0200X
ALMD.41401207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care