Provider Demographics
NPI:1285201186
Name:LAUBACH, TYLER (DO)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:LAUBACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 HOSPITAL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4568
Mailing Address - Country:US
Mailing Address - Phone:707-463-7495
Mailing Address - Fax:707-462-3063
Practice Address - Street 1:260 HOSPITAL DR STE 103
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4568
Practice Address - Country:US
Practice Address - Phone:707-463-7495
Practice Address - Fax:707-462-3063
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-10583207Q00000X
WAOP61561024207Q00000X
CA20A24539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine