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NPI Code Detail

MEDICARE: TYLER INTERNAL MEDICINE ASSOCIATES, P.A.

MEDICARE: TYLER INTERNAL MEDICINE ASSOCIATES, P.A.
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
1207Q00000XFamily Medicine Physician
2363A00000XPhysician Assistant
3363L00000XNurse Practitioner
4207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10059EHOTHERTXBCBS
21770695850OTHERTXNPI

General Provider Information

NPI Number : 1770695850
Entity Type Code : Organization
Provider Name (Legal Business Name) : TYLER INTERNAL MEDICINE ASSOCIATES, P.A.
Provider Business Mailing Address
First Line : 1910 ROSELAND BLVD
Second Line :
City : TYLER
State : TX
Zip : 75701-4246
Country : US
Telephone Number : 903-533-0644
Fax Number : 903-533-0441
Provider Business Practice Location Address
First Line : 1910 ROSELAND BLVD
Second Line :
City : TYLER
State : TX
Zip : 75701-4246
Country : US
Telephone Number : 903-533-0644
Fax Number : 903-533-0441
Authorized Official
Title or Position : OWNER
Name : DR. THOMAS BUZBEE
Credential : M.D.
Telephone Number : 903-533-0644
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/21/2022

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