Healthcare Provider Details

I. General information

NPI: 1104245141
Provider Name (Legal Business Name): TYLER ROWEN BEALS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

IV. Provider business mailing address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-7157
  • Fax: 970-495-7639
Mailing address:
  • Phone: 970-495-7157
  • Fax: 970-495-7639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0065956
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: