Provider Demographics
NPI:1255311288
Name:GIBB, TYLER DOUGLASS (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:DOUGLASS
Last Name:GIBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:400 NE MOTHER JOSEPH PL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3200
Practice Address - Country:US
Practice Address - Phone:360-425-5131
Practice Address - Fax:360-425-5509
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000345122085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0402006OtherL&I-SEATTLE RADIOLOGY
OR150946Medicaid
WA0383458OtherL&I-RADIA VANCOUVER
WA0422055OtherL&I-SWEDISH RADIA EDMONDS
WA0383459OtherL&I-RADIA SEATTLE
WA0422056OtherL&I-EVERGREEN RADIA
WA0415512OtherL&I-SOUTH SOUND RADIOLOGY
WA1005976Medicaid