MEDICARE: TYLER DAVIS

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	103T00000X	Psychologist	4485	AZ

General Provider Information

NPI Number	:	1881013266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER DAVIS

Provider Business Mailing Address
First Line	:	8607 N 59TH AVE
Second Line	:	#C-6
City	:	GLENDALE
State	:	AZ
Zip	:	85302-5433
Country	:	US
Telephone Number	:	602-753-8040
Fax Number	:

Provider Business Practice Location Address
First Line	:	8607 N 59TH AVE
Second Line	:	#C-6
City	:	GLENDALE
State	:	AZ
Zip	:	85302-5433
Country	:	US
Telephone Number	:	602-753-8040
Fax Number	:

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	04/14/2014

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Directions to “ TYLER DAVIS ” Practice Location

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