Individual
TYLER TAIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
(918) 458-2406
Mailing address
313 S 13TH AVE, HATTIESBURG, MS 39401-6238
(601) 624-8199
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/16/2015
Last updated
05/06/2015
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