Provider Demographics
NPI:1467611996
Name:SPATA, TYLER COOLEY (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:COOLEY
Last Name:SPATA
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 1:2700 E 29TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2507
Mailing Address - Country:US
Mailing Address - Phone:979-776-0750
Mailing Address - Fax:979-776-0750
Practice Address - Street 1:2700 E 29TH ST STE 105
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2507
Practice Address - Country:US
Practice Address - Phone:979-776-0750
Practice Address - Fax:979-776-0750
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
TXS6746208G00000X
CODR.0060440208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program