Provider Demographics
NPI:1417390543
Name:GREEN, TYLER (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 AIRPORT RD SW STE 212
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5848
Mailing Address - Country:US
Mailing Address - Phone:256-784-7336
Mailing Address - Fax:
Practice Address - Street 1:2004 AIRPORT RD SW STE 212
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5848
Practice Address - Country:US
Practice Address - Phone:256-784-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2286207R00000X
ALMD.35234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine