Healthcare Provider Details

I. General information

NPI: 1689817371
Provider Name (Legal Business Name): MARYELIZABETH TYLER JAMES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. MARYELIZABETH TYLER RASHID

II. Dates (important events)

Enumeration Date: 04/11/2009
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N WILLIAM KUMPF BLVD
PEORIA IL
61605-2507
US

IV. Provider business mailing address

303 N WILLIAM KUMPF BLVD
PEORIA IL
61605-2507
US

V. Phone/Fax

Practice location:
  • Phone: 309-676-5546
  • Fax: 309-676-5045
Mailing address:
  • Phone: 309-676-5546
  • Fax: 309-676-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number036128794
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036128794
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036128794
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: