Provider Demographics
NPI:1821384959
Name:CHAN, TYLER (MD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CHAN
Suffix:
Gender:
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:9399 CROWN CREST BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8571
Mailing Address - Country:US
Mailing Address - Phone:720-330-1310
Mailing Address - Fax:720-452-2082
Practice Address - Street 1:9399 CROWN CREST BLVD STE 240
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8571
Practice Address - Country:US
Practice Address - Phone:720-330-1310
Practice Address - Fax:720-452-2082
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.58644208600000X
PAMT200524208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000153081Medicaid