MEDICARE: WILLIAM A. TISDALL, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	208VP0014X	Interventional Pain Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760994420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM A. TISDALL, M.D., P.A.

Provider Business Mailing Address
First Line	:	1919 ROGERS RD STE 104
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4775
Country	:	US
Telephone Number	:	210-541-0700
Fax Number	:	210-541-6868

Provider Business Practice Location Address
First Line	:	1314 E SONTERRA BLVD STE 2107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4286
Country	:	US
Telephone Number	:	210-541-0700
Fax Number	:	210-541-6868

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM ALEC TISDALL
Credential	:
Telephone Number	:	210-541-0700

Provider Enumeration Date	:	11/02/2017
Last Update Date	:	11/02/2017

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Directions to “WILLIAM A. TISDALL, M.D., P.A. ” Practice Location

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