Healthcare Provider Details

I. General information

NPI: 1013610195
Provider Name (Legal Business Name): ALEXANDER TYLER PROUTY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N MAIN ST STE G-35
ENGLEWOOD OH
45415-1182
US

IV. Provider business mailing address

1 WYOMING ST
DAYTON OH
45409-2722
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-6784
  • Fax:
Mailing address:
  • Phone: 937-208-8000
  • Fax:

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: