Healthcare Provider Details

I. General information

NPI: 1164136552
Provider Name (Legal Business Name): TYLOR WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 01/10/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3D MARINE RAIDER BATTALION
FPO AA
28542-0073
US

IV. Provider business mailing address

PSC BOX 20073
FPO AA
28542-0073
US

V. Phone/Fax

Practice location:
  • Phone: 910-440-1947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: