MEDICARE: TYLER ANDREW MORK D.O.

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
1	207R00000X	Internal Medicine Physician	125-053512	IL
2	207R00000X	Internal Medicine Physician	2011008548	MO

General Provider Information

NPI Number	:	1477736320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER ANDREW MORK D.O.

Provider Business Mailing Address
First Line	:	PO BOX 955534
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-5534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8670 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-3839
Country	:	US
Telephone Number	:	314-447-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2007
Last Update Date	:	11/10/2020

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