Healthcare Provider Details

I. General information

NPI: 1205837994
Provider Name (Legal Business Name): STEVEN SHELBY TYNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ROUND ROCK AVE
ROUND ROCK TX
78681
US

IV. Provider business mailing address

PO BOX 10202
AUSTIN TX
78766-1202
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-1000
  • Fax: 512-671-8548
Mailing address:
  • Phone: 817-284-9850
  • Fax: 817-284-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG8999
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: