Provider Demographics
NPI:1154619856
Name:TYSON, KIRT (N,MD)
Entity type:Individual
Prefix:DR
First Name:KIRT
Middle Name:
Last Name:TYSON
Suffix:
Gender:M
Credentials:N,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N CENTER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6600
Mailing Address - Country:US
Mailing Address - Phone:480-834-5414
Mailing Address - Fax:480-834-5418
Practice Address - Street 1:210 N CENTER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6600
Practice Address - Country:US
Practice Address - Phone:480-834-5414
Practice Address - Fax:480-834-5418
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath