Individual
DR. JOHN D. TYLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2100 S COLUMBIA RD, STE 202, GRAND FORKS, ND 58201-5895
(701) 772-1588
(701) 746-6077
Mailing address
2100 S COLUMBIA RD, STE 202, GRAND FORKS, ND 58201-5895
(701) 772-1588
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
37
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005663645
AETNA
TX
05
—
16979
—
ND
01
—
2H520TY
MN BLUE CROSS
MN
01
—
974701009768
PREFERRED ONE
MN
01
—
A006
TRICARE
—
01
—
TYL5227
ND BLUE CROSS
ND
Enumeration date
07/20/2006
Last updated
07/08/2007
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