MEDICARE: DR. TROY ALAN TYNER D.O.,F.A.C.O.I.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	34004819T	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	110066031	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000016541	OTHER	OH	ANTHEM
4	2128988	OTHER	OH	AETNA
5	311346460028	OTHER	OH	CARESOURCE

General Provider Information

NPI Number	:	1003814526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TROY ALAN TYNER D.O.,F.A.C.O.I.

Provider Business Mailing Address
First Line	:	2510 COMMONS BLVD
Second Line	:	SUITE 210
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-3820
Country	:	US
Telephone Number	:	937-429-0607
Fax Number	:	937-558-3067

Provider Business Practice Location Address
First Line	:	2510 COMMONS BLVD
Second Line	:	SUITE 210
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-3820
Country	:	US
Telephone Number	:	937-429-0607
Fax Number	:	937-558-3067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	02/14/2014

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Directions to “ DR. TROY ALAN TYNER D.O.,F.A.C.O.I.” Practice Location

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