Healthcare Provider Details

I. General information

NPI: 1013438787
Provider Name (Legal Business Name): TYLER J. STEPHENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N HUSER ST
SYRACUSE KS
67878-7700
US

IV. Provider business mailing address

700 N HUSER ST
SYRACUSE KS
67878-7700
US

V. Phone/Fax

Practice location:
  • Phone: 620-384-7461
  • Fax: 620-384-5500
Mailing address:
  • Phone: 620-384-7461
  • Fax: 620-384-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0441882
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: