Individual provider · NPI-1

Tyler John Back, PA-C

Physician Assistant · Robbinsdale, MN

NPI number1144704867
StatusActive
Last updated in NPPESSep 19, 2018

Details

NPI
1144704867
Entity type
Individual (NPI-1)
Name
Tyler John Back
Credential
PA-C
Sex
Male
Sole proprietor
No
Enumeration date
Sep 19, 2018
Last updated
Sep 19, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician Assistant––Yes

Practice location

3366 Oakdale Ave N Ste 303
Robbinsdale, MN 55422-2977

Phone 763-520-7700 · Fax 763-520-7776

Mailing address

3366 Oakdale Ave N Ste 303
Robbinsdale, MN 55422-2977

Phone 763-520-7700 · Fax 763-520-7776

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