Provider Demographics
NPI:1578995049
Name:ANDERSON, TYLER EVAN (RPA, RT(R))
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:EVAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:RPA, RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 GLENROTHES CV
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-7985
Mailing Address - Country:US
Mailing Address - Phone:213-444-9173
Mailing Address - Fax:
Practice Address - Street 1:400 ASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6134
Practice Address - Country:US
Practice Address - Phone:919-371-2371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant