Individual provider Active NPI

Tyler Davis, DO

  • Trauma Surgery Physician
  • Tyler, TX
National Provider Identifier
1003439803
Registry record updated Apr 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
License
W1769 Issued in TX
Practice address
11937 US Highway 271
Tyler, TX 75708-3154
Phone
(903) 877-7777
NPI assigned
May 27, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Trauma Surgery Physician 2086S0127X W1769 TX Primary

Addresses

Primary practice location

11937 US Highway 271
Tyler, TX 75708-3154

Mailing address

11937 US Highway 271
Tyler, TX 75708-3154
Phone (903) 877-7777

Other practice location 1

630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL kate.wells@uthct.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200629002866 TX Order and Referring Only - General SurgeryPractitioner - General Surgery 6103248612
I20250814003397 GA Order and Referring Only - General SurgeryPractitioner - General Surgery 6103248612

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of North Texas HSC, College of Osteopathic Med, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2900 Saint Michael Dr
Suite 307
Texarkana, TX 75503-2343

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
W1769TXMDTrauma Surgery Physician

Interoperability endpoints

  • Direct secure messaging: tdavis355120@ahs.direct-ci.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776297600000",
    "number": "1003439803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11937 US HIGHWAY 271",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757083154",
            "telephone_number": "903-877-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11937 US HIGHWAY 271",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757083154",
            "telephone_number": "903-877-7777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "630 S Fleishel Ave",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757012041",
            "country_code": "US",
            "telephone_number": "903-606-5560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "TYLER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-27",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "TX",
            "license": "W1769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "kate.wells@uthct.edu",
            "affiliation": "N",
            "address_1": "11937 US Highway 271",
            "city": "Tyler",
            "state": "TX",
            "country_code": "US",
            "postal_code": "757083154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.