Jared J Tyson MD PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

8915908-1205 Issued in UT

Legal business name

JARED J TYSON MD PC

Practice address

1551 Renaissance Towne Dr
Suite 400
Bountiful, UT 84010-7667

Phone

(801) 295-7200

Fax

(801) 295-4930

NPI assigned

Jan 28, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Annette Simmons

Title

Office Manager

Phone

(801) 295-7200

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422403200000",
    "number": "1306236492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 RENAISSANCE TOWNE DR",
            "address_2": "SUITE 400",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107667",
            "telephone_number": "801-295-7200",
            "fax_number": "801-295-4930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 RENAISSANCE TOWNE DR",
            "address_2": "SUITE 400",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107667",
            "telephone_number": "801-295-7200",
            "fax_number": "801-295-4930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JARED J TYSON MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-28",
        "last_updated": "2015-01-28",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "801-295-7200"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "UT",
            "license": "8915908-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shanna Joy Jaggers
• James E Russon DDS PC
• James H. Martineau, DMD, PLLC
• Shane James, M.S. CCC-SLP
• Launee Lyn Janes, COTA
• Carmela J Javellana, MD
• Garrett Tanner Jefferies
• Jeffery R. Oka, M.D., P.C.
• Sydney R Jeffries, LCSW
• Mardiene Jeffs, PA-C

• Specialist in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Specialist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.