Provider Demographics
NPI:1467241570
Name:TYSON MEDICAL INC
Entity type:Organization
Organization Name:TYSON MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-592-4351
Mailing Address - Street 1:420 SUNFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-3243
Mailing Address - Country:US
Mailing Address - Phone:951-593-2747
Mailing Address - Fax:
Practice Address - Street 1:400 MARY AVE
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2875
Practice Address - Country:US
Practice Address - Phone:760-592-4351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TYSON MEDICAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty