Healthcare Provider Details

I. General information

NPI: 1649153594
Provider Name (Legal Business Name): J TYLER MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 QUARRY LEDGE RD
ROCA NE
68430-4284
US

IV. Provider business mailing address

5200 QUARRY LEDGE RD
ROCA NE
68430-4284
US

V. Phone/Fax

Practice location:
  • Phone: 402-587-2312
  • Fax:
Mailing address:
  • Phone: 402-587-2312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number17566
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number17566
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: