MEDICARE: JAMES WENDELL TYSON M.D.

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	207U00000X	Nuclear Medicine Physician	24603	AZ
2	2085R0202X	Diagnostic Radiology Physician	24603	AZ

General Provider Information

NPI Number	:	1568669265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WENDELL TYSON M.D.

Provider Business Mailing Address
First Line	:	2709 W PLACITA MESA ALTA
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-8735
Country	:	US
Telephone Number	:	520-531-8362
Fax Number	:	520-531-8392

Provider Business Practice Location Address
First Line	:	2709 W PLACITA MESA ALTA
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-8735
Country	:	US
Telephone Number	:	520-531-8362
Fax Number	:	520-531-8392

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	09/11/2025

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