Provider Demographics
NPI:1275890329
Name:TYLER, JOHN OLIVER III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:OLIVER
Last Name:TYLER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249-1900
Mailing Address - Country:US
Mailing Address - Phone:205-934-9666
Mailing Address - Fax:
Practice Address - Street 1:6624 FANNIN ST STE 1990
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2330
Practice Address - Country:US
Practice Address - Phone:713-796-2668
Practice Address - Fax:713-790-0591
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ9919207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program