Basic Information
| Provider Information | |||||||||
| NPI: | 1861983348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEACH | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | JON | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 990 E STATE ROAD 44 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461319199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177368474 | ||||||||
| FaxNumber: | 3177366040 | ||||||||
| Practice Location | |||||||||
| Address1: | 990 E STATE ROAD 44 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461319199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177368474 | ||||||||
| FaxNumber: | 3177366040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2018 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | IN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 02006216 | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.