Individual
JON E TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6410 FANNIN ST, 500, HOUSTON, TX 77030-3000
(832) 325-7111
(713) 500-5711
Mailing address
PO BOX 201088, HOUSTON, TX 77216-1088
(713) 500-3500
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
E5270
TX
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
E5270
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84511Y
BCBS
TX
Enumeration date
06/22/2006
Last updated
02/12/2008
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