Provider Demographics
NPI:1811969140
Name:TYLER, BRIAN C (MD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:TYLER
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:PO BOX 710
Mailing Address - Street 2:MULBERRY PEDIATRICS
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-0710
Mailing Address - Country:US
Mailing Address - Phone:828-757-5509
Mailing Address - Fax:828-757-5538
Practice Address - Street 1:401 MULBERRY ST SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5463
Practice Address - Country:US
Practice Address - Phone:828-757-5509
Practice Address - Fax:828-757-5538
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601121208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891251FMedicaid
NCH10661Medicare UPIN