Provider Demographics
NPI:1740228261
Name:TYLER ANESTHESIA GROUP, PA
Entity Type:Organization
Organization Name:TYLER ANESTHESIA GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:214-522-0210
Mailing Address - Street 1:PO BOX 140069
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-0069
Mailing Address - Country:US
Mailing Address - Phone:214-522-0210
Mailing Address - Fax:214-522-0474
Practice Address - Street 1:3414 GOLDEN RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8336
Practice Address - Country:US
Practice Address - Phone:903-597-0601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty