Healthcare Provider Details

I. General information

NPI: 1447385034
Provider Name (Legal Business Name): TYLER R SCIMECA M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 W ROSE GARDEN LN
PHOENIX AZ
85027-2530
US

IV. Provider business mailing address

1820 PRESTON PARK BLVD 1200
PLANO TX
75093-3656
US

V. Phone/Fax

Practice location:
  • Phone: 623-931-7999
  • Fax: 623-842-5640
Mailing address:
  • Phone: 972-867-7862
  • Fax: 972-612-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number41848
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: