Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | G3873 | TX |
NPI | 1881783413 |
---|---|
Provider Name | Dr. Edward P Tyson |
First Address | Austin, TX 78746-6459 |
Second Address | Austin, TX 78746-6459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 04/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B27161 | (02) |