Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 06005989A | IN |
Y | 213ES0000X | Sports Medicine | 06005989A | IN |
NPI | 1366084915 |
---|---|
Provider Name | Tyler William Maharrey |
First Address | Winslow, IN 47598-8455 |
Second Address | Jasper, IN 47546-1881 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2019 |
Last Update Date | 15/10/2019 |