Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CHR.0008143 | CO |
NPI | 1336789924 |
---|---|
Provider Name | Tyler A Gaines |
First Address | Castle Rock, CO 80104-1888 |
Second Address | Castle Rock, CO 80104-1888 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2020 |
Last Update Date | 10/01/2020 |