Individual
CATHERINE M TISDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8431 FREDERICKSBURG RD, #100, SAN ANTONIO, TX 78229-3392
(210) 615-7171
(210) 615-6793
Mailing address
8431 FREDERICKSBURG RD, #100, SAN ANTONIO, TX 78229-3392
(210) 615-7171
(210) 615-6793
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M5220
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00203V
MEDICARE PTAN GROUP
TX
01
—
207N00000X
TAXONOMONY
TX
01
—
742935457
TAX ID
TX
01
—
8X5051
BCBS
TX
01
—
DG9652
MEDICARE RR GROUP PTAN
TX
01
—
M5220
LICENSE
TX
01
—
P00605100
MEDICARE RR
TX
Enumeration date
04/12/2006
Last updated
10/27/2009
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