Provider Demographics
NPI:1205991684
Name:TYBURCZY, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:TYBURCZY
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 1:1995 ERRECART BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8336
Mailing Address - Country:US
Mailing Address - Phone:775-738-3111
Mailing Address - Fax:775-777-0216
Practice Address - Street 1:1995 ERRECART BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8336
Practice Address - Country:US
Practice Address - Phone:775-738-3111
Practice Address - Fax:775-778-6728
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5949208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002004014Medicaid
NV5949OtherMEDICAL BOARD
NVCS05099OtherSTATE PHARMACY
NVCS05099OtherSTATE PHARMACY
NV5949OtherMEDICAL BOARD