Provider Demographics
NPI:1194356915
Name:HUNTINGTON, TYLER GARRETT
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:GARRETT
Last Name:HUNTINGTON
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 1:6464 SW BORLAND RD STE A2
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8854
Mailing Address - Country:US
Mailing Address - Phone:503-885-1515
Mailing Address - Fax:503-885-1520
Practice Address - Street 1:6464 SW BORLAND RD STE A2
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8854
Practice Address - Country:US
Practice Address - Phone:503-885-1515
Practice Address - Fax:503-885-1520
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant