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General NPI Number Information
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NPI Number | 1982841870
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Entity Type | Individual
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Provider Name | TYRAN LANCE MERCER R.P.A.
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Gender | Male
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 3019 WILLOW OAK LN
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City | SEALY
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State | TX
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Zip | 77474-9270
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Country | US
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Telephone | 979-877-0081
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Fax |
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Provider Business Mailing Address
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Address Line | 3019 WILLOW OAK LN
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City | SEALY
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State | TX
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Zip | 77474-9270
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Country | US
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Telephone | 979-877-0081
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 243U00000X
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Taxonomy Name | Radiology Practitioner Assistant
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License Number | 08 TX 1362
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License Number State | TX
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