Provider Demographics
NPI:1780682054
Name:TYLER,, THOM L (MD, PA)
Entity type:Individual
Prefix:DR
First Name:THOM
Middle Name:L
Last Name:TYLER,
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 W NEWBERRY RD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4381
Mailing Address - Country:US
Mailing Address - Phone:352-333-5000
Mailing Address - Fax:352-333-5006
Practice Address - Street 1:6440 W NEWBERRY RD
Practice Address - Street 2:SUITE 408
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4381
Practice Address - Country:US
Practice Address - Phone:352-333-5000
Practice Address - Fax:352-333-5006
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36132207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066787100Medicaid
FL066787100Medicaid
FLD50080Medicare UPIN