Provider Demographics
NPI:1235347154
Name:ARKLESS, TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:ARKLESS
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 1:788 ROUTE 4 APT 902
Mailing Address - Street 2:
Mailing Address - City:SINAJANA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-3356
Mailing Address - Country:US
Mailing Address - Phone:671-688-0258
Mailing Address - Fax:
Practice Address - Street 1:300 S 6TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:AZ
Practice Address - Zip Code:86046-0110
Practice Address - Country:US
Practice Address - Phone:928-635-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46609207Q00000X
GUM1835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH109328Medicaid
OR1407812365OtherGROUP NPI NORTH BEND MEDICAL CENTER
93-0721250OtherTIN
OR161133OtherGROUP MEDICAID NORTH BEND MEDICAL CENTER
ORR0000WCHTWMedicare PIN
ORR0000WFBTVOtherGROUP MEDICARE NORTH BEND MEDICAL CENTER
GUH107356Medicare Oscar/Certification