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General NPI Number Information
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NPI Number | 1740206226
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Entity Type | Organization
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Legal Business Name | TYSON FAMILY MEDICAL P.C.
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 11/12/2007
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Provider Practice Location Address
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Address Line | 2831 TYSON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-1415
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Country | US
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Telephone | 267-350-5575
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Fax | 215-624-0874
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Provider Business Mailing Address
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Address Line | 2831 TYSON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-1415
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Country | US
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Telephone | 267-350-5575
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Fax | 215-624-0874
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID M PUDLES
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Credential | D.O
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Telephone | 267-350-5575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS005343-L
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License Number State | PA
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