Provider Demographics
NPI:1447453071
Name:QUY, TYSON (MD)
Entity type:Individual
Prefix:DR
First Name:TYSON
Middle Name:
Last Name:QUY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 W MEMORIAL RD STE 135
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1787
Mailing Address - Country:US
Mailing Address - Phone:405-286-1344
Mailing Address - Fax:405-849-4934
Practice Address - Street 1:4401 W MEMORIAL RD STE 135
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1787
Practice Address - Country:US
Practice Address - Phone:405-286-1344
Practice Address - Fax:405-849-4934
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25749207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200205210AMedicaid
OKOKA105561Medicare UPIN