Healthcare Provider Details

I. General information

NPI: 1982125076
Provider Name (Legal Business Name): TROY K TYLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 KING ST STE 200
JACKSONVILLE FL
32204-4736
US

IV. Provider business mailing address

201 NW R D MIZE RD
BLUE SPRINGS MO
64014-2513
US

V. Phone/Fax

Practice location:
  • Phone: 904-384-3343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2017018675
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberOS20586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: