Healthcare Provider Details

I. General information

NPI: 1508123167
Provider Name (Legal Business Name): TYLER ALAN CARSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W AVENUE M4
PALMDALE CA
93551-1432
US

IV. Provider business mailing address

400 N PEPPER AVE GENERAL SURGERY MOB STE#308
COLTON CA
92324-1801
US

V. Phone/Fax

Practice location:
  • Phone: 661-480-2377
  • Fax: 661-480-2378
Mailing address:
  • Phone: 909-580-1366
  • Fax: 909-580-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number20A12979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: