Healthcare Provider Details

I. General information

NPI: 1184156671
Provider Name (Legal Business Name): TYLER ROBERT YOUNGMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 N CENTRAL EXPY STE 500
DALLAS TX
75231-0805
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8233
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 214-220-2468
  • Fax: 469-232-9738
Mailing address:
  • Phone: 314-514-3500
  • Fax: 314-747-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number2022012664
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberS5180
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: