Provider Demographics
NPI:1053631069
Name:HARRISON, TYE B (DO)
Entity Type:Individual
Prefix:
First Name:TYE
Middle Name:B
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2561 S 1560 W STE B
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2361
Mailing Address - Country:US
Mailing Address - Phone:801-505-0821
Mailing Address - Fax:801-505-0803
Practice Address - Street 1:600 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3006
Practice Address - Country:US
Practice Address - Phone:435-734-2041
Practice Address - Fax:435-723-8028
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2023-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT9857371-1204207QS0010X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine