Provider Demographics
NPI:1205883154
Name:TYLER, SHANNON K (MD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:K
Last Name:TYLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5890
Mailing Address - Fax:251-471-7925
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:MASTIN BLDG.
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-470-5890
Practice Address - Fax:251-471-7925
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL24784207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL92-00090OtherUNITED HEALTHCARE
AL009935856Medicaid
MS07639500Medicaid
AL51535529OtherBCBS
AL51535531OtherBCBS
FL274994700Medicaid
AL009935857Medicaid
LA1582034Medicaid
AL51535531OtherBCBS
FL274994700Medicaid
AL51557385Medicare ID - Type UnspecifiedRAILROAD PGBA