MEDICARE: GILMAN R TYLER MD PA

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	2086S0129X	Vascular Surgery Physician	ME48678	FL
2	208600000X	Surgery Physician	ME48678	FL

General Provider Information

NPI Number	:	1245471069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILMAN R TYLER MD PA

Provider Business Mailing Address
First Line	:	602 S AUDUBON AVE
Second Line	:	STE A
City	:	TAMPA
State	:	FL
Zip	:	33609-4217
Country	:	US
Telephone Number	:	813-877-1415
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 S AUDUBON AVE
Second Line	:	STE A
City	:	TAMPA
State	:	FL
Zip	:	33609-4217
Country	:	US
Telephone Number	:	813-877-1415
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	JENNIFER MARTINEZ
Credential	:
Telephone Number	:	813-496-1075

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	12/14/2010

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