Basic Information
| Provider Information | |||||||||
| NPI: | 1750709796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEEL | ||||||||
| FirstName: | TYSON | ||||||||
| MiddleName: | DEAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1308 8TH ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | RUPERT | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833501535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084364322 | ||||||||
| FaxNumber: | 2084361312 | ||||||||
| Practice Location | |||||||||
| Address1: | 1308 8TH ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | RUPERT | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833501535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084364322 | ||||||||
| FaxNumber: | 2084361312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2014 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | O0888 | ID | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.