Doctor Name: | TYLER C MAXSON |
NPI Number: | 1417399098 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A. |
License Number: | |
Business Practice Address: | 14780 W. Mountain View Blvd. Suite 110 Surprise, AZ - 853747280 |
Business Phone Number: | 6233747774 |
Business Fax Number: | 8777965302 |
Mailing Address: | 14780 W. Mountain View Blvd., Suite 110 SURPRISE |
State: | AZ |
Postal Code: | 853747280 |
Phone Number: | 4805937384 |
Fax Number: | 8777965302 |
NPI Enumeration Date: | 07/23/2013 |
NPI Last Update Date: | 10/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |