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General NPI Number Information
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NPI Number | 1740697093
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Entity Type | Organization
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Legal Business Name | DAVID TYSON MHT LLC
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 1215 S COULTER ST STE 100
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City | AMARILLO
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State | TX
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Zip | 79106-1758
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Country | US
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Telephone | 806-359-4701
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 HERITAGE DRIVE SUITE 110
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City | MCKINNEY
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State | TX
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Zip | 75069-3379
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Country | US
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Telephone | 972-616-4702
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID TYSON
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Credential | MD
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Telephone | 806-359-4701
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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 | K0565
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License Number State | TX
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