Healthcare Provider Details

I. General information

NPI: 1053946269
Provider Name (Legal Business Name): TYLER GENE SANDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901 N RODNEY PARHAM RD STE 7
LITTLE ROCK AR
72212-4165
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-614-2663
  • Fax: 501-686-6260
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE-20629
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: