Provider Demographics
NPI:1730963133
Name:DOERR, TYLER JOSEPH
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JOSEPH
Last Name:DOERR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 MOUNT VERNON CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1854
Mailing Address - Country:US
Mailing Address - Phone:317-893-6332
Mailing Address - Fax:
Practice Address - Street 1:3743 LANDMARK DR STE 200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-6656
Practice Address - Country:US
Practice Address - Phone:765-448-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28274312A163W00000X
IN71015759A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse