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NPI Code Detail

MEDICARE: TYLER WING

MEDICARE: TYLER WING
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1528516143
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER WING
Provider Business Mailing Address
First Line : PO BOX 8459
Second Line :
City : PORTLAND
State : OR
Zip : 97207-8459
Country : US
Telephone Number : 707-572-7548
Fax Number :
Provider Business Practice Location Address
First Line : 1825 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2844
Country : US
Telephone Number : 707-572-7548
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2016
Last Update Date : 12/03/2019

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Directions to “ TYLER WING ” Practice Location

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