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General NPI Number Information
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NPI Number | 1730963133
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Entity Type | Individual
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Provider Name | TYLER JOSEPH DOERR
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Gender | Male
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 3743 LANDMARK DR STE 200
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City | LAFAYETTE
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State | IN
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Zip | 47905-6656
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Country | US
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Telephone | 765-448-4511
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Fax |
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Provider Business Mailing Address
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Address Line | 1098 MOUNT VERNON CT
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City | GREENWOOD
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State | IN
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Zip | 46142-1854
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Country | US
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Telephone | 317-893-6332
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 71015759A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28274312A
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License Number State | IN
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