Provider Demographics
NPI:1518095355
Name:PAYTON, TYLER WEST JR (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:WEST
Last Name:PAYTON
Suffix:JR
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 1:1194 BOBCAT BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1102
Mailing Address - Country:US
Mailing Address - Phone:505-856-1541
Mailing Address - Fax:
Practice Address - Street 1:1194 BOBCAT BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-1102
Practice Address - Country:US
Practice Address - Phone:505-856-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70-70174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMC98025Medicare UPIN
NM2127666Medicare ID - Type Unspecified