MEDICARE: RICHARD L TYLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	H9438	TX
2	207Q00000X	Family Medicine Physician	R4156	AR

General Provider Information

NPI Number	:	1144220542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD L TYLER MD

Provider Business Mailing Address
First Line	:	5002 COWHORN CREEK RD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-9766
Country	:	US
Telephone Number	:	903-614-3000
Fax Number	:	903-614-3525

Provider Business Practice Location Address
First Line	:	815 N KINGS HWY
Second Line	:
City	:	WAKE VILLAGE
State	:	TX
Zip	:	75501-5700
Country	:	US
Telephone Number	:	903-614-3700
Fax Number	:	903-614-3525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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