Provider Demographics
NPI:1407302888
Name:MURRAY, TYSON COLTER (MMS)
Entity type:Individual
Prefix:MR
First Name:TYSON
Middle Name:COLTER
Last Name:MURRAY
Suffix:
Gender:
Credentials:MMS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22601 N 19TH AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-1324
Mailing Address - Country:US
Mailing Address - Phone:602-293-3277
Mailing Address - Fax:602-283-4518
Practice Address - Street 1:22601 N 19TH AVE STE 112
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1324
Practice Address - Country:US
Practice Address - Phone:602-293-3277
Practice Address - Fax:602-283-4518
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ6558363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical