Most Relevant Information
Provider Data
| NPI Number: | 1003211103 |
| Provider Name: | TYLER ROTH LARSON PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 10001988A |
Most Important Dates
| Enumeration Date: | 10/31/2014 |
| Last Updated: | 11/27/2023 |
Provider Practice Location
1289 49TH AVE
SWEET HOME
OR
97386
Practice Location Phone/Fax
| Phone: | 5414516250 |
| Fax: |
Provider Mailing Location
PO BOX 1189
CORVALLIS
OR
973391189
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |