Provider Demographics
NPI:1952862146
Name:POLLEY, TYSON (DO)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:
Last Name:POLLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5055 E BROADWAY BLVD STE A100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:1866 E INNOVATION PARK DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1963
Practice Address - Country:US
Practice Address - Phone:520-825-2520
Practice Address - Fax:520-825-2501
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2022-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ009580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine