Individual
DR. LEE A. TISDALE
Active
Individual
DR. LEE A. TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
J8148
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129005807
—
TX
05
—
129005809
—
TX
01
—
8EH575
BCBS
TX
01
—
P01331283
RR
TX
Enumeration date
12/27/2005
Last updated
07/25/2022
Update your record
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