Provider Demographics
NPI:1871550129
Name:TYSON, DUNCAN (MD)
Entity type:Individual
Prefix:
First Name:DUNCAN
Middle Name:
Last Name:TYSON
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 1:1594 FREEDOM BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6046
Mailing Address - Country:US
Mailing Address - Phone:843-664-9696
Mailing Address - Fax:
Practice Address - Street 1:1594 FREEDOM BLVD
Practice Address - Street 2:STE 202
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6046
Practice Address - Country:US
Practice Address - Phone:843-664-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC094347Medicaid
SC6341OtherMEDICARE GROUP
SC080144136OtherRAILROAD MEDICARE
SCB918076341Medicare PIN
SC080144136OtherRAILROAD MEDICARE