Basic Information
| Provider Information | |||||||||
| NPI: | 1952333940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEI | ||||||||
| FirstName: | TYRONE | ||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26060 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937296060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594554000 | ||||||||
| FaxNumber: | 5594554007 | ||||||||
| Practice Location | |||||||||
| Address1: | 9200 SE 91ST AVE | ||||||||
| Address2: | #330 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037747700 | ||||||||
| FaxNumber: | 5037747701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 2085R0202X | 271493 | OR | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 8433955 | 01 | WA | WA MEDICAL | OTHER |