Provider Demographics
NPI:1881658706
Name:TYLER, ERIC OWEN (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:OWEN
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 1269
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35011-1269
Mailing Address - Country:US
Mailing Address - Phone:256-234-5021
Mailing Address - Fax:256-234-5640
Practice Address - Street 1:1962 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3437
Practice Address - Country:US
Practice Address - Phone:256-234-5021
Practice Address - Fax:256-234-5640
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00010362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51014753OtherBLUE CROSS/BLUE SHIELD
AL51014753OtherBLUE CROSS/BLUE SHIELD