Healthcare Provider Details

I. General information

NPI: 1770695850
Provider Name (Legal Business Name): TYLER INTERNAL MEDICINE ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 ROSELAND BLVD
TYLER TX
75701-4246
US

IV. Provider business mailing address

1910 ROSELAND BLVD
TYLER TX
75701-4246
US

V. Phone/Fax

Practice location:
  • Phone: 903-533-0644
  • Fax: 903-533-0441
Mailing address:
  • Phone: 903-533-0644
  • Fax: 903-533-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS BUZBEE
Title or Position: OWNER
Credential: M.D.
Phone: 903-533-0644