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General NPI Number Information
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NPI Number | 1205314028
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Entity Type | Individual
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Provider Name | TYLER JOHN DUGGAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 1117 ROUTE 46 STE 301
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City | CLIFTON
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State | NJ
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Zip | 07013-2450
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Country | US
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Telephone | 973-270-9906
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MILTON PL APT B
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City | MORRISTOWN
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State | NJ
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Zip | 07960-3791
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00483800
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License Number State | NJ
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