Provider Demographics
NPI:1013404284
Name:BONE, TYLER MICHAEL
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:MICHAEL
Last Name:BONE
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 1:621 EAST MATTHEWS AVENUE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-932-6799
Mailing Address - Fax:870-932-8423
Practice Address - Street 1:621 EAST MATTHEWS AVENUE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-0001
Practice Address - Country:US
Practice Address - Phone:870-932-6799
Practice Address - Fax:970-932-8423
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-16313207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program