Provider Demographics
NPI:1619991452
Name:CAMPBELL, TYLER J (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:J
Last Name:CAMPBELL
Suffix:
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 1:17862 STATE ROUTE 247
Mailing Address - Street 2:
Mailing Address - City:SEAMAN
Mailing Address - State:OH
Mailing Address - Zip Code:45679-8002
Mailing Address - Country:US
Mailing Address - Phone:937-695-0748
Mailing Address - Fax:937-286-0010
Practice Address - Street 1:17862 STATE ROUTE 247
Practice Address - Street 2:
Practice Address - City:SEAMAN
Practice Address - State:OH
Practice Address - Zip Code:45679-8002
Practice Address - Country:US
Practice Address - Phone:937-695-0748
Practice Address - Fax:937-286-0010
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2570801Medicaid
OH316402534OtherTAX ID NUMBER
OH316402534OtherTAX ID NUMBER
OH4156452Medicare ID - Type Unspecified