Individual
DR. TYLER JAMES WILLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
933 E PIERCE ST, COUNCIL BLUFFS, IA 51503-4626
(712) 396-4360
(712) 396-7069
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD-41201
IA
208M00000X
Hospitalist Physician
Primary
MD-41201
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026327300
—
NE
05
—
1407167620
—
IA
Enumeration date
06/23/2010
Last updated
09/08/2017
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