Healthcare Provider Details

I. General information

NPI: 1811627227
Provider Name (Legal Business Name): MR. TYLER THOMAS ZEHR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S 11TH ST STE 3
COEUR D ALENE ID
83814-4000
US

IV. Provider business mailing address

212 S 11TH ST STE 3
COEUR D ALENE ID
83814-4000
US

V. Phone/Fax

Practice location:
  • Phone: 208-274-0167
  • Fax:
Mailing address:
  • Phone: 208-274-0167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3771287
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: