Provider Demographics
NPI:1205356482
Name:NICHOLSON, TYLER CLARE (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:CLARE
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5005 N. PIEDRAS ST.
Mailing Address - Street 2:WILLIAM BEAUMONT ARMY MEDICAL CENTER ATTN: GME
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-2597
Mailing Address - Fax:915-742-6666
Practice Address - Street 1:5005 N. PIEDRAS ST.
Practice Address - Street 2:WILLIAM BEAUMONT ARMY MEDICAL CENTER ATTN: GME
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-742-2597
Practice Address - Fax:915-742-6666
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2023-06-08
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Provider Licenses
StateLicense IDTaxonomies
WI72278-20207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program