Provider Demographics
NPI:1053830463
Name:SCHMIDTHUBER, TYSON MARQUIS (DPM)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:MARQUIS
Last Name:SCHMIDTHUBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N EL CAMINO REAL STE 201
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1335
Mailing Address - Country:US
Mailing Address - Phone:650-793-6287
Mailing Address - Fax:
Practice Address - Street 1:501 N EL CAMINO SUITE 201
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-436-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5654213ES0103X
IL135000987213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery