Provider Demographics
NPI:1952975971
Name:SHRIVER, TYLER J (DO)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:SHRIVER
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 1:205 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:KS
Mailing Address - Zip Code:66945-8924
Mailing Address - Country:US
Mailing Address - Phone:785-337-2214
Mailing Address - Fax:
Practice Address - Street 1:205 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:KS
Practice Address - Zip Code:66945-8924
Practice Address - Country:US
Practice Address - Phone:785-337-2214
Practice Address - Fax:785-337-2727
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSPENDING207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine