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General NPI Number Information
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NPI Number | 1881058303
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Entity Type | Organization
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Legal Business Name | DOUGLAS TYLER M.D. A PROFESSIONAL
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 2811 WILSHIRE BLVD SUITE 800
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City | SANTA MONICA
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State | CA
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Zip | 90403-4803
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Country | US
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Telephone | 310-828-0733
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Fax | 310-828-0711
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Provider Business Mailing Address
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Address Line | PO BOX 641115
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City | LOS ANGELES
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State | CA
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Zip | 90064-6115
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Country | US
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Telephone | 310-470-0386
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Fax | 310-694-0119
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Authorized Official
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Title or Position | OWNER
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Name | DOUGLAS TYLER
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Credential | M.D.
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Telephone | 310-828-0733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G42734
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License Number State | CA
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