Provider Demographics
NPI:1447202528
Name:TYRRELL, JAMES BLAKELY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BLAKELY
Last Name:TYRRELL
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 1:559 E ALISAL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-2516
Mailing Address - Country:US
Mailing Address - Phone:831-769-1304
Mailing Address - Fax:831-757-0291
Practice Address - Street 1:1441 CONSTITUTION BLVD
Practice Address - Street 2:BLDG 151 SUITE 16
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-755-8640
Practice Address - Fax:831-769-8632
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23986207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA946000524OtherEIN COUNTY OF MONTEREY
CA946000524OtherEIN COUNTY OF MONTEREY
CAZZZ02040ZMedicare ID - Type UnspecifiedLINKED GRP LAUREL CLINICS