License holder summary

ANDREW CHARLES TISTADT is a Board Of Medicine licensed to practice in Idaho. The address on file for ANDREW CHARLES TISTADT is 20663 NW ROCKSPRING LANE BEAVERTON OR 97006. This licensed professional license is not current. The license was granted 04/03/2006 and expired on 04/22/2006.

Idaho

Division of Occupational and Professional Licenses

ANDREW CHARLES TISTADT
Board Of Medicine
License number
PAT-476
Date granted
04/03/2006
Date expires
04/22/2006
Class
Board Of Medicine
Status
Expired
Address
20663 NW ROCKSPRING LANE BEAVERTON OR 97006
idaholicensing.com
ID 48332083
LAST UPDATED 2026-05-21 05:26:16 UTC

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