Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2019-00680 | NC |
Y | 207X00000X | Orthopaedic Surgeon | E-13051 | AR |
NPI | 1003228891 |
---|---|
Provider Name | Dr. Tyler Lewis Carllee |
First Address | Little Rock, AR 72205-7101 |
Second Address | Little Rock, AR 72205-7101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 10/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0397730007 | NSC# (01) | NC |