Provider Demographics
NPI:1447385034
Name:SCIMECA, TYLER R (M D)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:R
Last Name:SCIMECA
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 1:1820 PRESTON PARK BLVD
Mailing Address - Street 2:1200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3656
Mailing Address - Country:US
Mailing Address - Phone:972-867-7862
Mailing Address - Fax:972-612-1623
Practice Address - Street 1:2323 W ROSE GARDEN LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2530
Practice Address - Country:US
Practice Address - Phone:623-931-7999
Practice Address - Fax:623-842-5640
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ418482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ431473Medicaid
AZZ130542Medicare PIN
AZ431473Medicaid
AZZ130541Medicare PIN