Healthcare Provider Details

I. General information

NPI: 1912849480
Provider Name (Legal Business Name): TYLER CAMERON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MEDICAL PARK DRIVE SUITE 350
COLUMBIA SC
29203
US

IV. Provider business mailing address

14 MEDICAL PARK DRIVE SUITE 350
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-3790
  • Fax:
Mailing address:
  • Phone: 803-434-3790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberLL97122
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: