Healthcare Provider Details

I. General information

NPI: 1558320408
Provider Name (Legal Business Name): LANCE M. TIGYER D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7980 N. MAIN ST.
DAYTON OH
45415-2328
US

IV. Provider business mailing address

7980 N. MAIN ST.
DAYTON OH
45415-2328
US

V. Phone/Fax

Practice location:
  • Phone: 937-280-4988
  • Fax: 937-280-4994
Mailing address:
  • Phone: 937-280-4988
  • Fax: 937-280-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number34.008657
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: