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NPI Code Detail

MEDICARE: MR. TYSON GABRIEL BAYNES PA-C

MEDICARE: MR. TYSON GABRIEL BAYNES PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant52496CA
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1114299781
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TYSON GABRIEL BAYNES PA-C
Provider Business Mailing Address
First Line : PO BOX 31396
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94598-8396
Country : US
Telephone Number : 925-939-8585
Fax Number : 925-933-2709
Provider Business Practice Location Address
First Line : 900 LAFAYETTE ST STE 105
Second Line :
City : SANTA CLARA
State : CA
Zip : 95050-4966
Country : US
Telephone Number : 408-293-7767
Fax Number : 408-300-9663
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2012
Last Update Date : 09/19/2024

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