Provider Demographics
NPI:1114010121
Name:TYON, WARREN GLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:GLEN
Last Name:TYON
Suffix:
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 1:2290 BURGETT RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36605-2801
Mailing Address - Country:US
Mailing Address - Phone:251-375-6843
Mailing Address - Fax:
Practice Address - Street 1:6801 AIRPORT BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3709
Practice Address - Country:US
Practice Address - Phone:251-633-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALMD.28017207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910138Medicaid
AL009910140Medicaid
AL510-05895OtherBCBS
AL009910137Medicaid
AL510-65681OtherBCBS
AL009910139Medicaid
AL1114010121OtherTRICARE SOUTH
AL510-05897OtherBCBS
AL510-05900OtherBCBS
AL009910137Medicaid
AL510-05895OtherBCBS