Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 01076691A | IN |
Y | 2080P0204X | Pediatric Emergency Doctor | 01076691A | IN |
NPI | 1083930234 |
---|---|
Provider Name | Tyler S Arnold |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Cincinnati, OH 45229-3039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2010 |
Last Update Date | 10/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201360550 | (05) | IN |