Provider Demographics
NPI:1245573815
Name:MCVAY, TYLER RODMAN (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:RODMAN
Last Name:MCVAY
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 1:3333 S. WADSWORTH BLVD.
Mailing Address - Street 2:BLDG D, STE 100
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227
Mailing Address - Country:US
Mailing Address - Phone:720-544-2064
Mailing Address - Fax:303-347-3080
Practice Address - Street 1:13111 E BRIARWOOD AVE STE 300
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3913
Practice Address - Country:US
Practice Address - Phone:303-671-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0061678207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79986013Medicaid