Provider Demographics
NPI:1861029019
Name:WOODWORTH, TYLER T (MD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:T
Last Name:WOODWORTH
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 1:9403 CROWN CREST BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8991
Mailing Address - Country:US
Mailing Address - Phone:720-638-7500
Mailing Address - Fax:303-269-2829
Practice Address - Street 1:9403 CROWN CREST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8991
Practice Address - Country:US
Practice Address - Phone:720-638-7500
Practice Address - Fax:303-269-2829
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12409924-1205208100000X
CODR.0075774208100000X
AZ72028208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ206392Medicaid