Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | MD175844 | OR |
Y | 207L00000X | Anesthesiologist | MD60821188 | WA |
NPI | 1003159096 |
---|---|
Provider Name | Dr. Tyler Justin Paradis |
First Address | Vancouver, WA 98664-1988 |
Second Address | Vancouver, WA 98664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2013 |
Last Update Date | 04/02/2022 |