Provider Demographics
NPI:1407302888
Name:MURRAY, TYSON COLTER (MMS)
Entity Type:Individual
Prefix:MR
First Name:TYSON
Middle Name:COLTER
Last Name:MURRAY
Suffix:
Gender:M
Credentials:MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6234 W BEHREND DR
Mailing Address - Street 2:1090
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6905
Mailing Address - Country:US
Mailing Address - Phone:406-403-1132
Mailing Address - Fax:
Practice Address - Street 1:6234 W BEHREND DR
Practice Address - Street 2:1090
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6905
Practice Address - Country:US
Practice Address - Phone:406-403-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical