Provider Demographics
NPI:1447218425
Name:ENDEAN, TY HOWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:HOWARD
Last Name:ENDEAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 N BEVERLY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2155
Mailing Address - Country:US
Mailing Address - Phone:152-324-6290
Mailing Address - Fax:520-324-9291
Practice Address - Street 1:1622 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4047
Practice Address - Country:US
Practice Address - Phone:520-323-5925
Practice Address - Fax:520-281-0189
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3953207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ808040Medicaid
AZ11334734OtherCAQH
AZH70232Medicare UPIN