Provider Demographics
NPI:1588058499
Name:MOUW, TYLER (MD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:MOUW
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 1:3601 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-0002
Mailing Address - Country:US
Mailing Address - Phone:806-743-2373
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-3700
Practice Address - Country:US
Practice Address - Phone:806-743-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-28
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT40072086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program