Provider Demographics
NPI:1689172868
Name:DIAL, TYLER ELLIOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:ELLIOTT
Last Name:DIAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2002 N CEDAR ST STE B
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3926
Mailing Address - Country:US
Mailing Address - Phone:910-272-3048
Mailing Address - Fax:910-738-3764
Practice Address - Street 1:923 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-9628
Practice Address - Country:US
Practice Address - Phone:910-521-0564
Practice Address - Fax:910-521-8091
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2020-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-07818363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant