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General NPI Number Information
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NPI Number | 1700470101
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Entity Type | Individual
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Provider Name | TYLER ANDERSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/25/2021
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 7700 S BROADWAY
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City | LITTLETON
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State | CO
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Zip | 80122-2602
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Country | US
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Telephone | 800-828-0898
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Fax |
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Provider Business Mailing Address
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Address Line | 2781 S NEWLAND ST
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City | DENVER
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State | CO
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Zip | 80227-3518
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Country | US
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Telephone | 303-941-0128
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0007470
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License Number State | CO
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