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General NPI Number Information
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NPI Number | 1972965127
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Entity Type | Individual
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Provider Name | TYLER PRIMAVERA D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2016
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 2735 SILVER CREEK RD
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-7924
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Country | US
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Telephone | 928-763-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 4401 HARRISON BLVD
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City | OGDEN
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State | UT
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Zip | 84403-3195
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Country | US
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Telephone | 801-387-2800
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 12576081-1204
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License Number State | UT
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