Individual
TYSON DEKORSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
475 W 940 N, PROVO, UT 84604-3301
(801) 357-7940
Mailing address
475 W 940 N, PROVO, UT 84604-3301
(801) 357-7940
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/24/2007
Last updated
01/12/2009
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