Provider Demographics
NPI:1225003577
Name:TYLER, LATONIA EVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:LATONIA
Middle Name:EVETTE
Last Name:TYLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LATONIA
Other - Middle Name:EVETTE
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6603 FIRST PARK TEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4303
Mailing Address - Country:US
Mailing Address - Phone:210-735-9461
Mailing Address - Fax:
Practice Address - Street 1:6603 FIRST PARK TEN BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4303
Practice Address - Country:US
Practice Address - Phone:210-735-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057585A207ZP0102X
TXN8357207ZP0102X
TN46379207ZP0102X
MNTELEMEDICINE 1616207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology