Provider Demographics
NPI:1881783413
Name:TYSON, EDWARD P (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:P
Last Name:TYSON
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 1:3811 BEE CAVES RD
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6459
Mailing Address - Country:US
Mailing Address - Phone:512-380-9999
Mailing Address - Fax:512-380-0072
Practice Address - Street 1:3811 BEE CAVES RD
Practice Address - Street 2:STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6459
Practice Address - Country:US
Practice Address - Phone:512-380-9999
Practice Address - Fax:512-380-0072
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3873207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B27161Medicare UPIN