Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0438024 | KS |
Y | 208000000X | Pediatrician | 2013005666 | MO |
N | 2084N0402X | Child Neurologist | 04-38024 | KS |
N | 2084N0402X | Child Neurologist | 2013005666 | MO |
NPI | 1407167372 |
---|---|
Provider Name | Dr. Tyler Jared Allison |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 01/07/2015 |