Individual
GAYLE HOLDERNESS TYERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
510 CYPRESS ST STE D, FORT BRAGG, CA 95437-5411
(707) 357-1001
Mailing address
510 CYPRESS ST STE D, FORT BRAGG, CA 95437-5411
(707) 964-5696
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G43243
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3116
CCS
CA
Enumeration date
06/19/2006
Last updated
06/20/2019
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