Organization
MONTLAKE DIAGNOSTICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM ALEC TISDALL M.D. (OWNER)
(210) 714-5532
Entity
Organization
Contact information
Practice address
1819 N MAIN AVE # 218, SAN ANTONIO, TX 78212-3941
(210) 714-5532
Mailing address
1819 N MAIN AVE # 218, SAN ANTONIO, TX 78212-3941
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
Primary
—
—
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
—
—
Other
Enumeration date
02/12/2016
Last updated
11/16/2016
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