Provider Demographics
NPI:1043301179
Name:TRYON, RANDY J (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:J
Last Name:TRYON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2305 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-1500
Mailing Address - Country:US
Mailing Address - Phone:828-692-7122
Mailing Address - Fax:828-692-8841
Practice Address - Street 1:2305 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-1500
Practice Address - Country:US
Practice Address - Phone:828-692-7122
Practice Address - Fax:828-692-8841
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC28703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC83887OtherBCBS
NC8983887Medicaid
NC203413Medicare ID - Type Unspecified
NC8983887Medicaid