Tyler J Roubidoux MD PC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

A127481 Issued in CA

Legal business name

TYLER J ROUBIDOUX MD PC

Practice address

11645 Wilshire Blvd Ste 987
Los Angeles, CA 90025-6814

Phone

(310) 393-9359

NPI assigned

Feb 26, 2018

Last updated

Apr 25, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tyler J Roubidoux, MD

Title

Sole Owner

Phone

(208) 305-3536

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1519603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524614400000",
    "number": "1619478567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7001",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913577001",
            "telephone_number": "818-888-7815",
            "fax_number": "818-715-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11645 WILSHIRE BLVD STE 987",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900256814",
            "telephone_number": "310-393-9359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYLER J ROUBIDOUX MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-26",
        "last_updated": "2018-04-25",
        "status": "A",
        "authorized_official_last_name": "ROUBIDOUX",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "208-305-3536",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A127481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Darlene Fay Tyler, RN, FNP
• Jay Tyler
• Jimmie Lee Tyler
• Maris Anne Tyler
• Shari D Tyler

• Anesthesiology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.