Basic Information
| Provider Information | |||||||||
| NPI: | 1073729174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRYON | ||||||||
| FirstName: | JOEY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 851 MIDDLE ST | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027211778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086893802 | ||||||||
| FaxNumber: | 5082355594 | ||||||||
| Practice Location | |||||||||
| Address1: | 851 MIDDLE ST | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027211778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086893802 | ||||||||
| FaxNumber: | 5082355594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 05/04/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 238666 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110082936A | 05 | MA | MEDICAID | 238666 | 01 | MA | MEDICAL LICENSE | OTHER |