Individual provider Active NPI

Ty M Tallman, N.M.D.

  • Naturopath
  • Mesa, AZ
National Provider Identifier
1770614307
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
NaturopathTaxonomy code 175F00000X
License
04-792 Issued in AZ
Practice address
1910 S Stapley Dr Ste 120
Mesa, AZ 85204-6676
Phone
(480) 219-2624
Fax
(888) 210-1237
NPI assigned
Mar 7, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Integrative Medicine Physician 202D00000X 04-792 AZ
Integrative Medicine Physician 202D00000X 4461 OR
Obesity Medicine (Preventive Medicine) Physician 2083B0002X 04-792 AZ
General Practice Physician 208D00000X 04-792 AZ
Naturopath 175F00000X 04-792 AZ Primary

Addresses

Primary practice location

1910 S Stapley Dr Ste 120
Mesa, AZ 85204-6676

Mailing address

11445 E Via Linda
Ste 2 #604
Scottsdale, AZ 85259-2655
Phone (480) 219-2624

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4461ORMDIntegrative Medicine Physician
04-792AZMDObesity Medicine (Preventive Medicine) Physician

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752451200000",
    "number": "1770614307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11445 E VIA LINDA",
            "address_2": "STE 2 #604",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852592655",
            "telephone_number": "480-219-2624",
            "fax_number": "480-629-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 S STAPLEY DR STE 120",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852046676",
            "telephone_number": "480-219-2624",
            "fax_number": "888-210-1237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALLMAN",
        "first_name": "TY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "N.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "202D00000X",
            "taxonomy_group": "",
            "desc": "Integrative Medicine",
            "state": "AZ",
            "license": "04-792",
            "primary": false
        },
        {
            "code": "202D00000X",
            "taxonomy_group": "",
            "desc": "Integrative Medicine",
            "state": "OR",
            "license": "4461",
            "primary": false
        },
        {
            "code": "2083B0002X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Obesity Medicine",
            "state": "AZ",
            "license": "04-792",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AZ",
            "license": "04-792",
            "primary": false
        },
        {
            "code": "175F00000X",
            "taxonomy_group": "",
            "desc": "Naturopath",
            "state": "AZ",
            "license": "04-792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; 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.