Individual
TYLER FANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1112 NW CIRCLE BLVD, CORVALLIS, OR 97330-1462
(541) 768-5235
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
042.0014873
VT
2084P0800X
Psychiatry Physician
Primary
MD216942
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2018
Last updated
09/19/2023
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