Provider Demographics
NPI:1164869061
Name:VETTEL, TYLER JAY (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAY
Last Name:VETTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9802
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-9802
Mailing Address - Country:US
Mailing Address - Phone:308-381-0162
Mailing Address - Fax:308-389-4445
Practice Address - Street 1:3563 PRAIRIEVIEW ST STE 300
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4442
Practice Address - Country:US
Practice Address - Phone:308-381-0162
Practice Address - Fax:308-389-4445
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine