Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | E7525 | TX |
N | 207Q00000X | Family Doctor | E7525 | TX |
NPI | 1053432351 |
---|---|
Provider Name | Michael Earl Tyler |
First Address | San Antonio, TX 78232-4321 |
Second Address | San Antonio, TX 78232-4321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C22866 | (02) | TX |