Provider Demographics
NPI:1861217960
Name:WOOD, TYLER DUANE
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:DUANE
Last Name:WOOD
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 1:2282 NW TROOST ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6072
Mailing Address - Country:US
Mailing Address - Phone:541-672-4798
Mailing Address - Fax:
Practice Address - Street 1:2282 NW TROOST ST STE 103
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6072
Practice Address - Country:US
Practice Address - Phone:541-672-4798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical