Provider Demographics
NPI:1073729174
Name:TRYON, JOEY A (DO)
Entity Type:Individual
Prefix:DR
First Name:JOEY
Middle Name:A
Last Name:TRYON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1778
Mailing Address - Country:US
Mailing Address - Phone:508-689-3802
Mailing Address - Fax:508-235-5594
Practice Address - Street 1:851 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1778
Practice Address - Country:US
Practice Address - Phone:508-689-3802
Practice Address - Fax:508-235-5594
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082936AMedicaid
MA238666OtherMEDICAL LICENSE
MA238666OtherMEDICAL LICENSE