Individual
DR. TYLER GROUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
120 HOSPITAL DR, STE 100, LEBANON, MO 65536-9238
(417) 533-6751
(417) 533-6755
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
2011018602
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851555312
—
MO
01
—
431560263
TRICARE
MO
01
—
P01159451
RR MCR
MO
Enumeration date
07/14/2008
Last updated
10/02/2014
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