Provider Demographics
NPI:1952300493
Name:TYLER, TERRY WHITMER (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:WHITMER
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 1:2200 E PARRISH AVE
Mailing Address - Street 2:BUILDING D
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-926-8171
Mailing Address - Fax:270-926-4574
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BUILDING D
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-926-8171
Practice Address - Fax:270-926-4574
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2008-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6417554000Medicaid
KY000000048252OtherANTHEM BCBS
KY000000568035OtherBCBS (COOPERATIVE HEALTH SERVICES INC.)
IN100014190Medicaid
KY1364101Medicare PIN
KY300017743Medicare PIN
IN100014190Medicaid
KY6417554000Medicaid