Provider Demographics
NPI:1700840584
Name:TYLER, EARL DAY (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:DAY
Last Name:TYLER
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:PO BOX 1888
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403
Mailing Address - Country:US
Mailing Address - Phone:800-945-2455
Mailing Address - Fax:903-453-2541
Practice Address - Street 1:4215 JOE RAMSEY BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75403
Practice Address - Country:US
Practice Address - Phone:903-408-5000
Practice Address - Fax:903-408-1249
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE54522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128446502Medicaid
D36004Medicare UPIN
TX128446502Medicaid
TX89R081Medicare PIN