Healthcare Provider Details

I. General information

NPI: 1528993821
Provider Name (Legal Business Name): TYLER A LAYSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 E HUALAPAI MOUNTAIN RD UNIT 1
KINGMAN AZ
86401-9503
US

IV. Provider business mailing address

4201 E HUALAPAI MOUNTAIN RD UNIT 1
KINGMAN AZ
86401-9503
US

V. Phone/Fax

Practice location:
  • Phone: 425-328-5038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR4982
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: