Provider Demographics
NPI:1982841870
Name:MERCER, TYRAN LANCE (RPA)
Entity Type:Individual
Prefix:MR
First Name:TYRAN
Middle Name:LANCE
Last Name:MERCER
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 WILLOW OAK LN
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-9270
Mailing Address - Country:US
Mailing Address - Phone:979-877-0081
Mailing Address - Fax:
Practice Address - Street 1:3019 WILLOW OAK LN
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-9270
Practice Address - Country:US
Practice Address - Phone:979-877-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08 TX 1362243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant