Provider Demographics
NPI:1588601843
Name:BURDEN, TYSON L (MD)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:L
Last Name:BURDEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2631 CUNNINGHAM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1543
Mailing Address - Country:US
Mailing Address - Phone:417-627-8967
Mailing Address - Fax:417-627-8951
Practice Address - Street 1:445 E 10TH ST
Practice Address - Street 2:
Practice Address - City:BAXTER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66713-1614
Practice Address - Country:US
Practice Address - Phone:620-856-3469
Practice Address - Fax:620-856-5330
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-01-16
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Provider Licenses
StateLicense IDTaxonomies
KS0427633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H30173Medicare UPIN