Provider Demographics
NPI:1821270877
Name:JAMES R TRYON M.D., PC
Entity Type:Organization
Organization Name:JAMES R TRYON M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-302-3048
Mailing Address - Street 1:4105 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1102
Mailing Address - Country:US
Mailing Address - Phone:505-737-9411
Mailing Address - Fax:505-884-6845
Practice Address - Street 1:4105 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1102
Practice Address - Country:US
Practice Address - Phone:505-737-9411
Practice Address - Fax:505-884-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-02
Last Update Date:2024-02-20
Deactivation Date:2008-07-31
Deactivation Code:
Reactivation Date:2008-09-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35025247Medicaid