NPI 1093925307

Tyra Denee Gaylord, MD

Practitioner Specialist South Bend, IN

Practice location

Address: 615 N Michigan St, South Bend, IN 46601-1033
Phone: (574) 647-1000
Mailing address: 15446 Regis CT, Granger, IN 46530-6266

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 01042658A (IN)

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Registry record

NPI: 1093925307
Entity type: Individual
Sex (as registered): Female
NPI issued: 23 May 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.