Provider Demographics
NPI:1386830222
Name:TYE, GRACE ANLON (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ANLON
Last Name:TYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 OAK LAWN AVE UNIT 192749
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4688
Mailing Address - Country:US
Mailing Address - Phone:844-389-5711
Mailing Address - Fax:877-880-2039
Practice Address - Street 1:2825 OAK LAWN AVE UNIT 192749
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4688
Practice Address - Country:US
Practice Address - Phone:844-389-5711
Practice Address - Fax:877-880-2039
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA926462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology