Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | TCHI-1824 | ID |
NPI | 1437658499 |
---|---|
Provider Name | Dr. Tyrel Kevin Ward |
First Address | Twin Falls, ID 83301-0278 |
Second Address | Twin Falls, ID 83301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2018 |
Last Update Date | 06/02/2018 |