Provider Demographics
NPI:1346207396
Name:TYLOR, OYA ALICE (MD)
Entity Type:Individual
Prefix:
First Name:OYA
Middle Name:ALICE
Last Name:TYLOR
Suffix:
Gender:F
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:PO BOX 7118
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7118
Mailing Address - Country:US
Mailing Address - Phone:480-899-1711
Mailing Address - Fax:480-857-6601
Practice Address - Street 1:250 E DUNLAP
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-251-5534
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19041207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0009240OtherBLUE SHIELD ARIZONA
AZ218653Medicaid
D00494Medicare UPIN