Healthcare Provider Details

I. General information

NPI: 1164719332
Provider Name (Legal Business Name): TYLER SCARBOROUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66A COURTHOUSE RD
CAMP LEJEUNE NC
28542-0183
US

IV. Provider business mailing address

PSC 20183
CAMP LEJEUNE NC
28542-0183
US

V. Phone/Fax

Practice location:
  • Phone: 910-440-7704
  • Fax: 910-440-7059
Mailing address:
  • Phone: 910-440-7704
  • Fax: 910-440-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: