Provider Demographics
NPI:1053601591
Name:BROLIN, TYLER JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JAMES
Last Name:BROLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S. GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2205
Mailing Address - Country:US
Mailing Address - Phone:901-759-3100
Mailing Address - Fax:901-759-3196
Practice Address - Street 1:1458 W POPLAR AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0630
Practice Address - Country:US
Practice Address - Phone:901-759-3100
Practice Address - Fax:901-759-3196
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24906207X00000X
PAMD457009207X00000X
TN55799207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR221116001Medicaid
MS100220409Medicaid
TNQ029821Medicaid
MS005234353Medicaid
MS05234353Medicaid