Provider Demographics
NPI:1750867768
Name:O'BRYAN, TYLER PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:PATRICK
Last Name:O'BRYAN
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 1:32 MALLETTS BAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1960
Mailing Address - Country:US
Mailing Address - Phone:802-655-4422
Mailing Address - Fax:
Practice Address - Street 1:32 MALLETTS BAY AVE STE B
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1960
Practice Address - Country:US
Practice Address - Phone:802-655-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0015603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine