Provider Demographics
NPI:1346500584
Name:FIALA, TYSON WILLIAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:TYSON
Middle Name:WILLIAM
Last Name:FIALA
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 1:40 FOUR MILE DR
Mailing Address - Street 2:STE 8
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2655
Mailing Address - Country:US
Mailing Address - Phone:281-370-0648
Mailing Address - Fax:
Practice Address - Street 1:40 FOUR MILE DR
Practice Address - Street 2:STE 8
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2655
Practice Address - Country:US
Practice Address - Phone:281-370-0648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT92518213ES0103X
TXT34-2011213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist