Healthcare Provider Details

I. General information

NPI: 1336501402
Provider Name (Legal Business Name): TYLER GRANT SLAYMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 2ND AVE STE 201B
CORALVILLE IA
52241-2225
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-467-2000
  • Fax: 319-467-2814
Mailing address:
  • Phone: 319-384-2000
  • Fax: 319-467-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD-46125
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-46125
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: