Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 047716 | NY |
NPI | 1386694644 |
---|---|
Provider Name | Dr. Donald Tyler JR. |
First Address | Fort Sam Houston, TX 78234-4504 |
Second Address | Jbsa Lackland, TX 78236-5638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 13/04/2021 |