Individual
DR. TYLER GUTHRIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 373-4000
(260) 482-4442
Mailing address
3640 NEW VISION DR, SUITE A, FORT WAYNE, IN 46845-1717
(260) 482-4440
(260) 482-4442
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02003913A
IN
207P00000X
Emergency Medicine Physician
5101018131
MI
390200000X
Student in an Organized Health Care Education/Training Program
5101018131
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201040270
—
IN
01
—
M400058749
MEDICARE WPS CMS
IN
Enumeration date
05/18/2009
Last updated
03/16/2016
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