Healthcare Provider Details

I. General information

NPI: 1376390104
Provider Name (Legal Business Name): TYLER AARON MOREY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BRIDGE ST STE 201
DANVILLE VA
24541
US

IV. Provider business mailing address

109 BRIDGE ST STE 201
DANVILLE VA
24541
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-4488
  • Fax: 434-773-6977
Mailing address:
  • Phone: 434-799-4488
  • Fax: 434-773-6977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116039131
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: