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General NPI Number Information
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NPI Number | 1003278730
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Entity Type | Individual
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Provider Name | TYLER T BIRCH D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 520 S EAGLE RD STE 3102
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City | MERIDIAN
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State | ID
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Zip | 83642-6352
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Country | US
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Telephone | 208-706-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 500 W FORT ST # 111R
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City | BOISE
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State | ID
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Zip | 83702-4501
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | O-1272
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License Number State | ID
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