Provider Demographics
NPI:1265856819
Name:HAMILTON, TYLER B (DO)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:B
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078
Mailing Address - Country:US
Mailing Address - Phone:270-988-3839
Mailing Address - Fax:270-988-3832
Practice Address - Street 1:117 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078
Practice Address - Country:US
Practice Address - Phone:270-988-3839
Practice Address - Fax:270-988-3832
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16462207Q00000X
KY04104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine