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NPI Code Detail

MEDICARE: TYLER MARK NIXON DO

MEDICARE: TYLER MARK NIXON DO
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
1208M00000XHospitalist Physician10699025-1204UT
2207R00000XInternal Medicine Physician10699025-1204UT

General Provider Information

NPI Number : 1669639985
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER MARK NIXON DO
Provider Business Mailing Address
First Line : PO BOX 5546
Second Line :
City : DENVER
State : CO
Zip : 80217-5546
Country : US
Telephone Number : 801-475-3500
Fax Number :
Provider Business Practice Location Address
First Line : 1916 N 700 W STE 250
Second Line :
City : LAYTON
State : UT
Zip : 84041-5723
Country : US
Telephone Number : 801-479-0312
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2008
Last Update Date : 09/20/2023

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