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Individual
TYLER JACOB REED
Active
Individual
TYLER JACOB REED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
75000108A
IN
367H00000X
Anesthesiologist Assistant
PENDING
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001654899
ANTHEM PTAN
IN
Enumeration date
06/23/2021
Last updated
12/02/2024
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