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NPI Code Detail

MEDICARE: TYSON QUY, M.D., INC.

MEDICARE: TYSON QUY, M.D., INC.
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
1207Q00000XFamily Medicine Physician25749OK

General Provider Information

NPI Number : 1497012017
Entity Type Code : Organization
Provider Name (Legal Business Name) : TYSON QUY, M.D., INC.
Provider Business Mailing Address
First Line : 1721 S AIR DEPOT BLVD
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73110-5103
Country : US
Telephone Number : 405-610-2447
Fax Number : 405-610-2086
Provider Business Practice Location Address
First Line : 1721 S AIR DEPOT BLVD
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73110-5103
Country : US
Telephone Number : 405-610-2447
Fax Number : 405-610-2086
Authorized Official
Title or Position : PHYSICIAN
Name : DR. TYSON DINH QUY
Credential : M.D.
Telephone Number : 405-610-2447
Provider Enumeration Date : 04/19/2012
Last Update Date : 10/31/2015

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