Provider Demographics
NPI:1003814526
Name:TYNER, TROY ALAN (DO,FACOI)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:ALAN
Last Name:TYNER
Suffix:
Gender:M
Credentials:DO,FACOI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 COMMONS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3820
Mailing Address - Country:US
Mailing Address - Phone:937-429-0607
Mailing Address - Fax:937-558-3067
Practice Address - Street 1:2510 COMMONS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3820
Practice Address - Country:US
Practice Address - Phone:937-429-0607
Practice Address - Fax:937-558-3067
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004819T207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0855678Medicaid
OH000000016541OtherANTHEM
OH110066031OtherRR MEDICARE
OH2128988OtherAETNA
OH311346460028OtherCARESOURCE
OH311346460028OtherCARESOURCE
OH000000016541OtherANTHEM