Provider Demographics
NPI:1619231214
Name:WARNER, TYLER DOUGLAS (D,O,)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:DOUGLAS
Last Name:WARNER
Suffix:
Gender:M
Credentials:D,O,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 MILL CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3226
Mailing Address - Country:US
Mailing Address - Phone:435-705-1984
Mailing Address - Fax:
Practice Address - Street 1:667 EASTLAND AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4503
Practice Address - Country:US
Practice Address - Phone:330-841-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.004389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine