MEDICARE: TYLER MARK NIXON DO, INC

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	207R00000X	Internal Medicine Physician	20A13158	CA

General Provider Information

NPI Number	:	1437532652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYLER MARK NIXON DO, INC

Provider Business Mailing Address
First Line	:	122 CALISTOGA RD
Second Line	:	SUITE 361
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-3702
Country	:	US
Telephone Number	:	253-212-7129
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 BROADWAY
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-7500
Country	:	US
Telephone Number	:	707-938-8406
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TYLER MARK NIXON
Credential	:	DO
Telephone Number	:	253-212-7129

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	07/16/2015

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