Provider Demographics
NPI:1033149067
Name:TYRANCE, PATRICK HENRY JR (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:HENRY
Last Name:TYRANCE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1612
Mailing Address - Country:US
Mailing Address - Phone:954-640-6010
Mailing Address - Fax:877-647-7874
Practice Address - Street 1:1100 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-1612
Practice Address - Country:US
Practice Address - Phone:954-640-6010
Practice Address - Fax:877-647-7874
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22468207X00000X
FLME123773207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00341847OtherRAILROAD MEDICARE
NE02671OtherBCBS OF NEBRASKA
NE10025562100Medicaid
FL141846792OtherUNITED HEALTH CARE
FL016556600Medicaid
NE07168OtherBCBS
FL0890216OtherCIGNA
IA2586594Medicaid
FLHQFJROtherBCBS
099588015OtherMEDICARE
NE280422Medicare PIN
FL0890216OtherCIGNA