Provider Demographics
NPI:1588243547
Name:WEST, TYLER MARTIN (MD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:MARTIN
Last Name:WEST
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 1:19475 OLD JETTON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-6591
Mailing Address - Country:US
Mailing Address - Phone:704-384-1775
Mailing Address - Fax:
Practice Address - Street 1:19475 OLD JETTON RD STE 200
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6591
Practice Address - Country:US
Practice Address - Phone:704-384-1775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCWEST-AY7ABN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine