Provider Demographics
NPI:1952478745
Name:TRYON, BRIAN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:TRYON
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD603662442085N0700X, 2085R0202X, 2085R0202X
ORMD274792085N0700X, 2085N0700X
IDM-122252085R0202X, 2085R0202X
CAA873772085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2002874Medicaid
WA326635OtherL&I PROVIDER ID
WA326643OtherL&I PROVIDER ID
WA326640OtherL&I PROVIDER ID
OR278890Medicaid
ID1952478745Medicaid
WA326637OtherL&I PROVIDER ID
WA326640OtherL&I PROVIDER ID
ORP00451090Medicare PIN
WAG8923547Medicare PIN
TXI35234Medicare UPIN
WA2002874Medicaid
OR138386Medicare PIN
WA326635OtherL&I PROVIDER ID
WAG8923544Medicare PIN
WA326637OtherL&I PROVIDER ID
WAP01277152Medicare PIN
WAG8923546Medicare PIN