Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 15676 | TX |
NPI | 1427311505 |
---|---|
Provider Name | Dr. Christopher L Tye |
First Address | Colleyville, TX 76034-6288 |
Second Address | Colleyville, TX 76034-6288 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 22/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110918303 | (05) | TX |
F31658 | (02) | TX |