Provider Demographics
NPI:1497012017
Name:TYSON QUY, M.D., INC.
Entity Type:Organization
Organization Name:TYSON QUY, M.D., INC.
Other - Org Name:AIR DEPOT FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:DINH
Authorized Official - Last Name:QUY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-610-2447
Mailing Address - Street 1:1721 S AIR DEPOT BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-5103
Mailing Address - Country:US
Mailing Address - Phone:405-610-2447
Mailing Address - Fax:405-610-2086
Practice Address - Street 1:1721 S AIR DEPOT BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-5103
Practice Address - Country:US
Practice Address - Phone:405-610-2447
Practice Address - Fax:405-610-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty