Healthcare Provider Details

I. General information

NPI: 1376920942
Provider Name (Legal Business Name): J TYLER ENDERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J TYLER ENDERS DO

II. Dates (important events)

Enumeration Date: 05/02/2015
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 N 92ND ST STE 225
SCOTTSDALE AZ
85258-4536
US

IV. Provider business mailing address

10200 N 92ND ST STE 225
SCOTTSDALE AZ
85258-4536
US

V. Phone/Fax

Practice location:
  • Phone: 480-697-4824
  • Fax: 480-697-4825
Mailing address:
  • Phone: 480-697-4824
  • Fax: 480-697-4825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101025644
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number009126
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: