Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Charles Girard Tisdale, PA-C

Individual provider Surgical Physician Assistant · NPI 1821096686

Charles Girard Tisdale, PA-C is a Physician Assistant in Shreveport, Louisiana. Qualified in 1997, 29 years ago. Practices with Musculoskeletal Institute of Louisiana LLC, a 28-clinician group and accepts Medicare assignment. Licensed in Louisiana.

Years since qualifying
29
Licensed in
LA
In the registry since
2005
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1500 Line Ave Ste 100
Shreveport, LA 71101-4644
Phone: (318) 635-3052
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA.A10284 (LA)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence A10284 (LA)

Record details

NPI number1821096686
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 14, 2005
Last updated in NPPESNovember 24, 2025
Certification dateNovember 24, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1997 (29 years in practice)
Group practice Musculoskeletal Institute Of Louisiana Llc — 28 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Shreveport