Healthcare Provider Details

I. General information

NPI: 1689133704
Provider Name (Legal Business Name): TYLER MILLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 S 500 E
OGDEN UT
84405-6905
US

IV. Provider business mailing address

2221 LAKESIDE BLVD STE 600
RICHARDSON TX
75082-4416
US

V. Phone/Fax

Practice location:
  • Phone: 800-880-3566
  • Fax: 801-432-2670
Mailing address:
  • Phone: 800-880-3566
  • Fax: 801-432-2670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11901382-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: