Individual
WILLIAM ALEC TISDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1919 ROGERS RD, SUITE 204, SAN ANTONIO, TX 78251-4614
(210) 541-0700
(210) 541-6868
Mailing address
1919 ROGERS RD, SUITE 204, SAN ANTONIO, TX 78251-4614
(210) 541-0700
(210) 541-6868
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
M5545
TX
208VP0014X
Interventional Pain Medicine Physician
Primary
M5545
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192493602
—
TX
01
—
8CK977
BLUE CROSS
TX
Enumeration date
02/22/2007
Last updated
01/04/2016
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