Healthcare Provider Details

I. General information

NPI: 1508156928
Provider Name (Legal Business Name): RICHARD OLIVER TYRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 CAUGHLIN XING STE 101
RENO NV
89519-0692
US

IV. Provider business mailing address

960 CAUGHLIN XING STE 100
RENO NV
89519-0692
US

V. Phone/Fax

Practice location:
  • Phone: 775-348-9798
  • Fax:
Mailing address:
  • Phone: 775-348-9798
  • Fax: 775-348-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number11250305-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD465033
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number26063
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number24166
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number0101272945
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: