Provider Demographics
NPI:1538622188
Name:OKELBERRY, TYLER DAVID (MD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:DAVID
Last Name:OKELBERRY
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 1:4403 HARRISON BLVD STE 2815
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3326
Mailing Address - Country:US
Mailing Address - Phone:801-387-7880
Mailing Address - Fax:801-387-7885
Practice Address - Street 1:4403 HARRISON BLVD STE 2815
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3326
Practice Address - Country:US
Practice Address - Phone:801-387-7880
Practice Address - Fax:801-387-7885
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13763082-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology