Individual
TYLER WAGSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
160 HERITAGE WAY STE 202, KALISPELL, MT 59901-3127
(406) 752-8433
(406) 756-6768
Mailing address
350 HERITAGE WAY STE 2100, KALISPELL, MT 59901-3167
(406) 257-8992
(406) 257-8996
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-79860
MT
363AS0400X
Surgical Physician Assistant
PA1227
ID
Other
Enumeration date
11/14/2013
Last updated
05/31/2023
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