Provider Demographics
NPI:1568669265
Name:TYSON, JAMES WENDELL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WENDELL
Last Name:TYSON
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 1:2709 W PLACITA MESA ALTA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-8735
Mailing Address - Country:US
Mailing Address - Phone:520-531-8362
Mailing Address - Fax:520-531-8392
Practice Address - Street 1:2709 W PLACITA MESA ALTA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-8735
Practice Address - Country:US
Practice Address - Phone:520-531-8362
Practice Address - Fax:520-531-8392
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24603207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology