MEDICARE: DR. TYSON K. MEYER MD

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
1	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	M8837	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8CH237	OTHER	TX	BLUECROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1508040361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYSON K. MEYER MD

Provider Business Mailing Address
First Line	:	605 E LOCUST AVE
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-3933
Country	:	US
Telephone Number	:	361-572-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 E LOCUST AVE
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-3933
Country	:	US
Telephone Number	:	361-572-4300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	06/24/2010

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