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General NPI Number Information
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NPI Number | 1649414525
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Entity Type | Individual
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Provider Name | JOHN R TISDALE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1811 RAHLING RD STE 120
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City | LITTLE ROCK
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State | AR
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Zip | 72223-4678
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Country | US
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Telephone | 501-214-2360
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Fax | 501-214-2356
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Provider Business Mailing Address
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Address Line | 4301 W MARKHAM ST # 783
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-686-8000
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Fax | 500-526-5148
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-18802
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35.121001
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-18802
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.121001
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License Number State | OH
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