Healthcare Provider Details

I. General information

NPI: 1841651825
Provider Name (Legal Business Name): TYLER RICHARD HARRELL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 22ND AVE
BROOKINGS SD
57006-2450
US

IV. Provider business mailing address

400 22ND AVE
BROOKINGS SD
57006-2450
US

V. Phone/Fax

Practice location:
  • Phone: 605-697-9500
  • Fax:
Mailing address:
  • Phone: 605-697-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number232
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: