person
Charles Girard Tisdale, PA-C
Surgical Physician Assistant in Shreveport, Louisiana
NPI 1821096686

Charles Girard Tisdale is a Surgical Physician Assistant based in Shreveport, LA and is specialized in Surgical. Charles Girard Tisdale practices in Shreveport, LA and has the professional credentials of PA-C. The NPI Number for Charles Girard Tisdale is 1821096686 and holds a License No. A10284 (Louisiana).

The current practice location address for Charles Girard Tisdale is 1455 E Bert Koun Loop, Shreveport, LA and can be reached out via phone at 318-798-4623 and via fax at 318-798-4569.

Location: 1455 E Bert Koun Loop, Shreveport, LA, 71105-5634
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Provider Profile Details
NPI Number
1821096686
Provider Name
Charles Girard Tisdale
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
1455 E Bert Koun Loop, Shreveport, LA, 71105-5634
Phone Number
318-798-4623
Fax Number
318-798-4569
Provider Enumeration Date
07/14/2005
Last Update Date
09/14/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1626708 05 LA
institution
Provider Business Practice Location Address Details
Address
1455 E Bert Koun Loop
City
State
Zip
71105-5634
Phone Number
318-798-4623
Fax Number
318-798-4569
person
Provider Business Mailing Address Details
Address
1455 E Bert Koun Loop
City
State
Zip
71105-5634
Phone Number
318-798-4623
Fax Number
318-798-4569
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
License No.
A10284 (Louisiana)
Definition
Definition to come...
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