Provider Demographics
NPI:1649614744
Name:RENCHER, TYLER W (DO)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:W
Last Name:RENCHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 S 1470 E STE 200
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1764
Mailing Address - Country:US
Mailing Address - Phone:435-688-0759
Mailing Address - Fax:435-656-0491
Practice Address - Street 1:630 S 400 E STE 101
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3765
Practice Address - Country:US
Practice Address - Phone:435-673-9653
Practice Address - Fax:435-673-9008
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9732596-1204207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program