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General NPI Number Information
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NPI Number | 1124448964
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Entity Type | Individual
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Provider Name | TYLER O STUTZMAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/20/2014
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Last Update Date | 06/15/2025
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Provider Practice Location Address
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Address Line | 890 OAK ST SE BLDG A
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City | SALEM
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State | OR
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Zip | 97301-3905
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Country | US
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Telephone | 503-814-1280
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Fax | 503-814-1070
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Provider Business Mailing Address
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Address Line | 271 FORT RICHARDSON AVE
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City | GOODFELLOW AFB
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State | TX
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Zip | 76908-4901
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Country | US
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Telephone | 325-654-3677
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA225085
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110005595
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License Number State | VA
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