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Individual
MR. LAMONT TYSON
Active
Individual
MR. LAMONT TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
227800000X
Certified Respiratory Therapist
Primary
A4816
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012AG
BCBS
NC
01
—
561924070
TAX ID
NC
05
—
7492717
—
NC
Enumeration date
01/11/2007
Last updated
04/24/2008
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