Individual
VICTOR C TISDAL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 EVERETT DR, 1NP606, OKLAHOMA CITY, OK 73104-5047
(405) 271-5068
Mailing address
1122 NE 13TH ST, ORI236, OKLAHOMA CITY, OK 73117-1039
(405) 271-1515
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
8972
OK
Other
Enumeration date
03/11/2006
Last updated
07/08/2007
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