Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 7578 | NE |
NPI | 1063894913 |
---|---|
Provider Name | Tyler Andrew Bliss |
First Address | Omaha, NE 68198-1225 |
Second Address | Omaha, NE 68198-1225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2015 |
Last Update Date | 26/06/2015 |