Individual
TYRA DENEE GAYLORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
615 N MICHIGAN ST, SOUTH BEND, IN 46601-1033
(574) 647-1000
Mailing address
15446 REGIS CT, GRANGER, IN 46530-6266
(574) 271-7295
(574) 271-1142
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01042658A
IN
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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