Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | G3859 | TX |
NPI | 1093769747 |
---|---|
Provider Name | Dr. Scott Christopher Tisdell |
First Address | Arlington, TX 76012 |
Second Address | Arlington, TX 76012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G3859 | (02) |