Individual
CHARLES GIRARD TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
A10284
LA
363AS0400X
Surgical Physician Assistant
Primary
PA.A10284
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1626708
—
LA
Enumeration date
07/14/2005
Last updated
11/24/2025
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