Individual
MR. TYLER ALAN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
888 S RANCHO DR, LAS VEGAS, NV 89106-3810
(702) 877-5199
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3203
(702) 838-1456
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO2471
NV
207Q00000X
Family Medicine Physician
SL1157
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V58740
MEDICARE
NV
Enumeration date
06/02/2016
Last updated
07/11/2019
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