MEDICARE: JEFFREY C. TYLER 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	207R00000X	Internal Medicine Physician	24982	CT

General Provider Information

NPI Number	:	1518938166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY C. TYLER M.D.

Provider Business Mailing Address
First Line	:	11 OLD PARK LN
Second Line	:
City	:	NEW MILFORD
State	:	CT
Zip	:	06776-2507
Country	:	US
Telephone Number	:	860-355-1149
Fax Number	:	860-355-5957

Provider Business Practice Location Address
First Line	:	11 OLD PARK LN
Second Line	:
City	:	NEW MILFORD
State	:	CT
Zip	:	06776-2507
Country	:	US
Telephone Number	:	860-355-1149
Fax Number	:	860-355-5957

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	07/08/2007

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