Healthcare Provider Details

I. General information

NPI: 1447218797
Provider Name (Legal Business Name): JOHN MARK TYLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13749 DEERFIELD LOOP
MEMPHIS IN
47143-9361
US

IV. Provider business mailing address

13749 DEERFIELD LOOP
MEMPHIS IN
47143-9361
US

V. Phone/Fax

Practice location:
  • Phone: 812-375-3906
  • Fax:
Mailing address:
  • Phone: 812-376-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01078698A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: