MEDICARE: MR. TYSON COLTER MURRAY M.M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	6558	AZ

General Provider Information

NPI Number	:	1407302888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TYSON COLTER MURRAY M.M.S.

Provider Business Mailing Address
First Line	:	22601 N 19TH AVE STE 112
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-1324
Country	:	US
Telephone Number	:	602-293-3277
Fax Number	:	602-283-4518

Provider Business Practice Location Address
First Line	:	22601 N 19TH AVE STE 112
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-1324
Country	:	US
Telephone Number	:	602-293-3277
Fax Number	:	602-283-4518

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	04/29/2025

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