Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 213803 | NY |
NPI | 1205892171 |
---|---|
Provider Name | Dr. John Marshall Tyo |
First Address | Amherst, NY 14226-3822 |
Second Address | Buffalo, NY 14222-2006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 30/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00020541001 | UNIVERA (01) | |
000525797001 | BC/BS (01) | |
0018460620001 | (05) | PA |
01988229 | (05) | NY |
040426001680 | FIDELIS (01) | |
3991525 | IHA (01) | |
H10401 | (02) |