MEDICARE: JOHN MASON TYLER JR. M.D.

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	30232	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487666376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MASON TYLER JR. M.D.

Provider Business Mailing Address
First Line	:	3910 S. CAREFREE CIRCLE
Second Line	:	SUITE C
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-3053
Country	:	US
Telephone Number	:	719-599-5753
Fax Number	:	719-599-5817

Provider Business Practice Location Address
First Line	:	3910 S. CAREFREE CIRCLE
Second Line	:	SUITE C
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-3053
Country	:	US
Telephone Number	:	719-599-5753
Fax Number	:	719-599-5817

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	12/19/2016

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