Individual
TYLER JAMES LACOSTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
777 BANNOCK ST, DENVER, CO 80204-4597
(303) 436-4949
(303) 602-5184
Mailing address
2472 RIDGEMONT DR, BIRMINGHAM, AL 35244-1251
(985) 518-2345
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
1543
AL
363AM0700X
Medical Physician Assistant
Primary
PA.0007592
CO
Other
Enumeration date
12/20/2019
Last updated
10/31/2024
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