Larson, Tyler Roth

Larson, Tyler Roth is an individual health care provider with primary practice located at 1289 49Th Ave , Sweet Home OR 97386. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Larson, Tyler Roth can be contacted via phone (541) 451-6250.

Contact Information

Primary practice address
1289 49Th Ave Sweet Home OR 97386
Phone: (541) 451-6250
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 10001988A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 50.004194 Ohio
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA201515 Oregon

Profile Details

NPI number 1003211103
LBN Legal business name Larson, Tyler Roth
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 31st, 2014
Last updated Nov 27th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003211103 NPPES
Indiana Other 000000985776 ANTHEM
Indiana MEDICAID 300003222 ANTHEM

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