Healthcare Provider Details

I. General information

NPI: 1477203529
Provider Name (Legal Business Name): TYLER A RUTHERFORD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 HIGHLAND AVE FL 2
CINCINNATI OH
45219-1976
US

IV. Provider business mailing address

3130 HIGHLAND AVE FL 2
CINCINNATI OH
45219-1976
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-7425
  • Fax: 513-584-7681
Mailing address:
  • Phone: 513-584-7425
  • Fax: 513-584-7681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: