Healthcare Provider Details

I. General information

NPI: 1710572763
Provider Name (Legal Business Name): TYLER KING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 12TH ST STE 605
PHOENIX AZ
85006-2850
US

IV. Provider business mailing address

1300 N 12TH ST STE 605
PHOENIX AZ
85006-2850
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-4567
  • Fax:
Mailing address:
  • Phone: 602-839-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01088186A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01088186A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number01088186A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number01088186A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: