Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 13529 | MN |
NPI | 1003203498 |
---|---|
Provider Name | Dr. Tyler John Varhol |
First Address | New Brighton, MN 55112-3517 |
Second Address | New Brighton, MN 55112-3517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2015 |
Last Update Date | 03/10/2019 |