Provider Demographics
NPI:1073013017
Name:GROTHUES, TYLER JAMES
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:GROTHUES
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 1:6535 CIRCLE OAK DR
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-2335
Mailing Address - Country:US
Mailing Address - Phone:830-370-3993
Mailing Address - Fax:
Practice Address - Street 1:6535 CIRCLE OAK DR
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-2335
Practice Address - Country:US
Practice Address - Phone:830-370-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX869605163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse