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NPI Code Detail

MEDICARE: TYLER SODERLING DO

MEDICARE: TYLER SODERLING DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1104575653
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER SODERLING DO
Provider Business Mailing Address
First Line : 2530 IOWA AVE
Second Line :
City : JOPLIN
State : MO
Zip : 64804-2721
Country : US
Telephone Number : 208-615-7898
Fax Number :
Provider Business Practice Location Address
First Line : 802 S JACKSON AVE STE 505
Second Line :
City : TULSA
State : OK
Zip : 74127-9060
Country : US
Telephone Number : 918-747-5322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2022
Last Update Date : 04/04/2022

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Directions to “ TYLER SODERLING DO” Practice Location

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