Provider Demographics
NPI:1598185381
Name:BACKLAS, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BACKLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800022
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0022
Mailing Address - Country:US
Mailing Address - Phone:719-776-4646
Mailing Address - Fax:719-776-4640
Practice Address - Street 1:3027 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1179
Practice Address - Country:US
Practice Address - Phone:719-776-4646
Practice Address - Fax:719-776-4640
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0058951207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine