Provider Demographics
NPI:1386650802
Name:SMITH, TYLER G (MD)
Entity Type:Individual
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First Name:TYLER
Middle Name:G
Last Name:SMITH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5 MEDICAL PLAZA DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2866
Mailing Address - Country:US
Mailing Address - Phone:916-352-0016
Mailing Address - Fax:916-229-0032
Practice Address - Street 1:5 MEDICAL PLAZA DR STE 120
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2866
Practice Address - Country:US
Practice Address - Phone:916-352-0016
Practice Address - Fax:916-229-0032
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2024-03-12
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Provider Licenses
StateLicense IDTaxonomies
CAA108880207XS0117X, 207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery