Individual
DR. TYLER J. PROUTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
527 MEDICAL PARK DR STE 205, BRIDGEPORT, WV 26330-9009
(304) 933-3800
(304) 933-3815
Mailing address
527 MEDICAL PARK DR STE 204, BRIDGEPORT, WV 26330-9009
(304) 933-3800
(304) 933-3815
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
22435
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22435
WV LICENSE
WV
05
—
3810009618
—
WV
01
—
4211642
MEDICARE PTAN
WV
Enumeration date
05/21/2007
Last updated
04/06/2022
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