Healthcare Provider Details

I. General information

NPI: 1831219377
Provider Name (Legal Business Name): DR. TYLER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N 4TH STREET
WASHINGTON MO
63090-2322
US

IV. Provider business mailing address

305 N 4TH STREET
WASHINGTON MO
63090-2322
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-2323
  • Fax: 636-239-7168
Mailing address:
  • Phone: 636-239-2323
  • Fax: 636-239-7168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number4945
License Number StateMO

VIII. Authorized Official

Name: LAWRENCE P. TYLER
Title or Position: OWNER/PROVIDER
Credential: D.C.
Phone: 636-239-2323