Healthcare Provider Details

I. General information

NPI: 1740596907
Provider Name (Legal Business Name): THOM L TYLER, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 W NEWBERRY RD STE 408
GAINESVILLE FL
32605-4370
US

IV. Provider business mailing address

6440 W NEWBERRY RD STE 408
GAINESVILLE FL
32605-4370
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5000
  • Fax: 352-333-5006
Mailing address:
  • Phone: 352-333-5000
  • Fax: 352-333-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME36132
License Number StateFL

VIII. Authorized Official

Name: THOM L TYLER
Title or Position: PRESIDENT
Credential: MD, PA
Phone: 352-333-5000