Healthcare Provider Details

I. General information

NPI: 1154153070
Provider Name (Legal Business Name): MR. TYLER SCOTT MOYER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 W OAK AVE
PANAMA CITY FL
32401-2735
US

IV. Provider business mailing address

97 W OAK AVE
PANAMA CITY FL
32401-2735
US

V. Phone/Fax

Practice location:
  • Phone: 850-381-4288
  • Fax:
Mailing address:
  • Phone: 850-381-4288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberEXEMPT
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: