Healthcare Provider Details

I. General information

NPI: 1093280570
Provider Name (Legal Business Name): TYLER JOSE DA COSTA DURAES AUD., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TYLER JOSE DURAES

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6925 HICKMAN RD
URBANDALE IA
50322-4805
US

IV. Provider business mailing address

6925 HICKMAN RD
URBANDALE IA
50322-4805
US

V. Phone/Fax

Practice location:
  • Phone: 515-276-6122
  • Fax: 515-237-3917
Mailing address:
  • Phone: 515-276-6122
  • Fax: 515-237-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number093393
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number093782
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: