Charles Girard Tisdale in Shreveport - Surgical
Charles Girard Tisdale - NPI 1821096686
Charles Girard Tisdale is a Surgical in Shreveport, Louisiana. Charles Girard Tisdale practices all healthcare services and medical treatments related to Surgical. The NPI Number for Charles Girard Tisdale is 1821096686. The last update date is 2020-12-11.
Charles Girard Tisdale's current location address is 1455 E Bert Koun Loop, Shreveport, Louisiana. You can contact this provider via phone number 3187984623 and fax number 3187984569. The mailing address for Charles Girard Tisdale is 1455 E Bert Koun Loop, Shreveport, Louisiana. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Charles Girard Tisdale |
|---|---|
| Address | 1455 E Bert Koun Loop, Shreveport, Louisiana |
| Phone Number | 3187984623 |
| Fax Number | 3187984569 |
| Sole Proprietor | N |
| Credentials | PA-C |
NPI Number Detail
| NPI Number | 1821096686 |
|---|---|
| Provider Enumeration Date | 2005-07-14 |
| Last Updated Date | 2020-12-11 |
Provider Mailing Address Detail
| Address | 1455 E Bert Koun Loop |
|---|---|
| City | Shreveport |
| State | Louisiana (LA) |
| Post Code | 711055634 |
| Phone Number | 3187984623 |
| Fax Number | 3187984569 |
Provider's Primary Taxonomy Detail
| Speciality | Surgical |
|---|---|
| Taxonomy | 363As0400X |
| Licence No | A10284 |
|
Definition: A licensed healthcare professional who assists in providing surgical care under physician supervision. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1626708 | LA | -- |
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What is the unique identification code assigned to Charles Girard Tisdale by the Centers for Medicare & Medicaid Services?
The Charles Girard Tisdale has been issued the NPI (National Provider Identifier) 1821096686. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please share the complete physical address where Charles Girard Tisdale is geographically located?
The Charles Girard Tisdale is physically situated at the following location: 1455 E Bert Koun Loop, Shreveport, LA, 711055634.
What is Charles Girard Tisdale's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Charles Girard Tisdale's specialized field of practice is Surgical, and the corresponding taxonomy code that categorizes this area of specialization is 363As0400X.
On what date did the Centers for Medicare & Medicaid Services issue the 1821096686 to Charles Girard Tisdale?
The Charles Girard Tisdale received its 1821096686 assignment from the Centers for Medicare & Medicaid Services on 2005-07-14.
As of what date were the Charles Girard Tisdale's details last updated?
The information pertaining to the Charles Girard Tisdale, including its address, specialty, and other details, was most recently updated on 2020-12-11.
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