Healthcare Provider Details

I. General information

NPI: 1205892171
Provider Name (Legal Business Name): JOHN MARSHALL TYO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT STREET
BUFFALO NY
14222-2006
US

IV. Provider business mailing address

4511 HARLEM ROAD SUITE 202
AMHERST NY
14226-3822
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-7109
  • Fax: 716-888-3874
Mailing address:
  • Phone: 716-839-6720
  • Fax: 716-839-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number213803
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: