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NPI Code Detail

MEDICARE: WILLIAM RAYMOND TYLER III

MEDICARE: WILLIAM RAYMOND TYLER III
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
12255A2300XAthletic TrainerAL2907FL

General Provider Information

NPI Number : 1497276885
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM RAYMOND TYLER III
Provider Business Mailing Address
First Line : 2667 BRUTON BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32805-5726
Country : US
Telephone Number : 407-206-8862
Fax Number :
Provider Business Practice Location Address
First Line : 2667 BRUTON BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32805-5726
Country : US
Telephone Number : 407-206-8862
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2017
Last Update Date : 07/21/2022

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Directions to “ WILLIAM RAYMOND TYLER III ” Practice Location

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