Healthcare Provider Details

I. General information

NPI: 1336778190
Provider Name (Legal Business Name): TYLER JAY HOMEWOOD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E HUNT HWY STE 18
SAN TAN VALLEY AZ
85143-4964
US

IV. Provider business mailing address

1620 N MAIN ST
SPANISH FORK UT
84660-1008
US

V. Phone/Fax

Practice location:
  • Phone: 480-400-5854
  • Fax:
Mailing address:
  • Phone: 480-400-5854
  • Fax: 866-913-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number011176
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberDO2025-0186
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: