Provider Demographics
NPI:1447202866
Name:TYRRELL, JOHN ERNEST (M D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ERNEST
Last Name:TYRRELL
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N FRANKLIN ST
Mailing Address - Street 2:P O BOX 220
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1518
Mailing Address - Country:US
Mailing Address - Phone:563-927-2539
Mailing Address - Fax:563-927-3705
Practice Address - Street 1:410 N FRANKLIN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-1518
Practice Address - Country:US
Practice Address - Phone:563-927-2539
Practice Address - Fax:563-927-3705
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0014209Medicaid
IA01420OtherWELLLMARK
IA01420OtherWELLLMARK