Tisdale, Charles Girard

Tisdale, Charles Girard is an individual health care provider with primary practice located at 1455 E Bert Koun Loop #210, Shreveport LA 71105-5634. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Tisdale, Charles Girard can be contacted via phone (318) 798-4623.

Contact Information

Primary practice address
1455 E Bert Koun Loop #210 Shreveport LA 71105-5634
Phone: (318) 798-4623
Fax: (318) 798-4569
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X A10284 Louisiana
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA.A10284 Louisiana

Profile Details

NPI number 1821096686
LBN Legal business name Tisdale, Charles Girard
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2005
Last updated Dec 11th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821096686 NPPES
Louisiana MEDICAID 1626708

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