Provider Demographics
NPI:1144704867
Name:BACK, TYLER JOHN (PA-C)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JOHN
Last Name:BACK
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3366 OAKDALE AVE N STE 303
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2977
Mailing Address - Country:US
Mailing Address - Phone:763-520-7700
Mailing Address - Fax:763-520-7776
Practice Address - Street 1:3366 OAKDALE AVE N STE 303
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2977
Practice Address - Country:US
Practice Address - Phone:763-520-7700
Practice Address - Fax:763-520-7776
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant