Provider Demographics
NPI:1245227263
Name:TYRING, STEPHEN KEITH (MD PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KEITH
Last Name:TYRING
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 N TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4927
Mailing Address - Country:US
Mailing Address - Phone:281-333-2288
Mailing Address - Fax:281-335-4605
Practice Address - Street 1:451 N TEXAS AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4927
Practice Address - Country:US
Practice Address - Phone:281-333-2288
Practice Address - Fax:281-335-4605
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5714207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B27159Medicare UPIN