Provider Demographics
NPI:1821379918
Name:TYSOME, JAMES RUSSELL (MS BS, FRCS(ORL-HNS))
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RUSSELL
Last Name:TYSOME
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Gender:M
Credentials:MS BS, FRCS(ORL-HNS)
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Mailing Address - Street 1:801 WELCH RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5739
Mailing Address - Country:US
Mailing Address - Phone:650-725-5968
Mailing Address - Fax:650-725-8502
Practice Address - Street 1:801 WELCH RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5739
Practice Address - Country:US
Practice Address - Phone:650-725-5968
Practice Address - Fax:650-725-8502
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAF5667207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology