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General NPI Number Information
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NPI Number | 1215101951
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Entity Type | Organization
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Legal Business Name | AUSTIN ROY TYRER, JR., M.D.
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 220 S CLAYBROOK ST #103
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City | MEMPHIS
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State | TN
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Zip | 38104-3527
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Country | US
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Telephone | 901-274-5881
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40835
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City | MEMPHIS
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State | TN
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Zip | 38174-0835
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Country | US
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Telephone | 901-274-5881
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AUSTIN ROY TYRER, JR
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Credential | M.D.
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Telephone | 901-274-5581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | MD0727
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License Number State | TN
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