Provider Demographics
NPI:1336555994
Name:NEAL, TYLER JORDAN (DO)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JORDAN
Last Name:NEAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 E EMPIRE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3630
Mailing Address - Country:US
Mailing Address - Phone:309-663-9300
Mailing Address - Fax:309-664-1382
Practice Address - Street 1:2406 E EMPIRE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3630
Practice Address - Country:US
Practice Address - Phone:309-663-9300
Practice Address - Fax:309-664-1382
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036152932207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery