| Doctor Name: | MR. TYLER LEE ANDERSON |
| NPI Number: | 1083927792 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA10003435 |
| Business Practice Address: | 1119 Highland Ave Ste 4 Clarkston, WA - 994032836 |
| Business Phone Number: | 5092540080 |
| Business Fax Number: | 5092540079 |
| Mailing Address: | 1119 Highland Ave Ste 4, CLARKSTON |
| State: | WA |
| Postal Code: | 994032836 |
| Phone Number: | 5092540080 |
| Fax Number: | 5092540079 |
| NPI Enumeration Date: | 07/22/2010 |
| NPI Last Update Date: | 07/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA10003435 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |