Provider Demographics
NPI:1114674439
Name:GAMBILL, TYLER J (BA)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:GAMBILL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 S 74TH WEST CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-4822
Mailing Address - Country:US
Mailing Address - Phone:918-605-4538
Mailing Address - Fax:
Practice Address - Street 1:7477 E 46TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-6305
Practice Address - Country:US
Practice Address - Phone:918-384-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator