Healthcare Provider Details

I. General information

NPI: 1215916168
Provider Name (Legal Business Name): RALPH R TYNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 DEXTER CT STE 101
DAVENPORT IA
52807-3471
US

IV. Provider business mailing address

3385 DEXTER CT STE 101
DAVENPORT IA
52807-3471
US

V. Phone/Fax

Practice location:
  • Phone: 563-359-1646
  • Fax:
Mailing address:
  • Phone: 563-359-1646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number26589
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: