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Individual
MR. TYLER ALAN PETERSON
Active
Individual
MR. TYLER ALAN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO2471
NV
207Q00000X
Family Medicine Physician
SL1157
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V58740
MEDICARE
NV
Enumeration date
06/02/2016
Last updated
07/11/2019
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