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Individual

MICHAEL R THYGERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
5880 S HOSPITAL DR, GLOBE, AZ 85501-9447
(928) 961-3902
Mailing address
PO BOX 386, GLOBE, AZ 85502-0386
(928) 961-3902

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
286558-4406
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
107013149101
IHC
UT
01
18330
HEALTHY U
UT
01
190683600
US DEPT OF LABOR
UT
01
28655844000001
BCBS
UT
01
70681
PEHP
UT
01
780194
DESERET MUTUAL
UT
01
870666269THY
EDUCATORS MUTUAL
UT
01
QM0000054865
ALTIUS
UT
01
TPRA08440
MOLINA
UT
Enumeration date
10/12/2006
Last updated
12/16/2009
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