Provider Demographics
NPI:1205227709
Name:NEWMAN, TYLER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 N 200 E STE 101
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1202
Mailing Address - Country:US
Mailing Address - Phone:435-787-0560
Mailing Address - Fax:435-752-4673
Practice Address - Street 1:434 E 5350 S STE D
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-827-9100
Practice Address - Fax:801-827-9110
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6609005-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant