Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 36897 | CO |
NPI | 1073620993 |
---|---|
Provider Name | Dr. Tyler M Lewark |
First Address | Denver, CO 80237-3486 |
Second Address | Aurora, CO 80012-4528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08580821 | (05) | CO |
1073620993 | (05) | WY |
12105864 | (05) | CO |