Provider Demographics
NPI:1215915988
Name:ANDERSON, TYRONE CHARLES JR (HEALTH SERVICES TECH)
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:CHARLES
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:HEALTH SERVICES TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 CYPRESS LAKES DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-6244
Mailing Address - Country:US
Mailing Address - Phone:860-625-0830
Mailing Address - Fax:860-439-1659
Practice Address - Street 1:COMDT (CG-1122), U.S. COAST GUARD2100 2ND ST SW
Practice Address - Street 2:SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:860-625-0830
Practice Address - Fax:860-439-1659
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other