Healthcare Provider Details

I. General information

NPI: 1326027103
Provider Name (Legal Business Name): THOMAS B. STYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 JAMES S. TRIMBLE BLVD.
PAINTSVILLE KY
41240-1055
US

IV. Provider business mailing address

PO BOX 409013
ATLANTA GA
30384-9013
US

V. Phone/Fax

Practice location:
  • Phone: 606-789-3511
  • Fax: 606-789-1432
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-523-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23196
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23196
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: