Healthcare Provider Details

I. General information

NPI: 1700400819
Provider Name (Legal Business Name): TYLER M YACHCIK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18511 HIGHLANDER MEDICS ST
EL PASO TX
79906-5327
US

IV. Provider business mailing address

18511 HIGHLANDER MEDICS ST
EL PASO TX
79906-5327
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-0730
  • Fax: 915-742-7889
Mailing address:
  • Phone: 915-742-0730
  • Fax: 915-742-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2529
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: