Provider Demographics
NPI:1164466124
Name:TYLER, GILMAN R JR (MD)
Entity type:Individual
Prefix:DR
First Name:GILMAN
Middle Name:R
Last Name:TYLER
Suffix:JR
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 1:3115 W OAKELLAR AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2917
Mailing Address - Country:US
Mailing Address - Phone:813-842-9412
Mailing Address - Fax:
Practice Address - Street 1:3115 W OAKELLAR AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2917
Practice Address - Country:US
Practice Address - Phone:813-842-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048678174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60937Medicare UPIN
FL02979Medicare ID - Type Unspecified