Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 11027336-1206 | UT |
NPI | 1003383480 |
---|---|
Provider Name | Andrew Tyler |
First Address | San Bernardino, CA 92423-0069 |
Second Address | Highland, CA 92346-3348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2018 |
Last Update Date | 20/11/2019 |