Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | J6783 | TX |
NPI | 1043238546 |
---|---|
Provider Name | Richard D Tyer |
First Address | Tyler, TX 75701-4225 |
Second Address | Tyler, TX 75701-4225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 13/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1044281 | (05) | TX |
G46836 | (02) | TX |