MEDICARE: MR. TYLER FLAVIN CPO

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	222Z00000X	Orthotist	1858	TX
2	332B00000X	Durable Medical Equipment & Medical Supplies	101279	TX

General Provider Information

NPI Number	:	1356006480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TYLER FLAVIN CPO

Provider Business Mailing Address
First Line	:	2122 BABCOCK RD STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4411
Country	:	US
Telephone Number	:	210-692-1111
Fax Number	:	210-692-6041

Provider Business Practice Location Address
First Line	:	2122 BABCOCK RD STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4411
Country	:	US
Telephone Number	:	210-692-1111
Fax Number	:	210-692-6041

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

Provider Enumeration Date	:	11/03/2021
Last Update Date	:	11/03/2021

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Directions to “ MR. TYLER FLAVIN CPO” Practice Location

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