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Individual
TYLER JAY STALEY
Active
Individual
TYLER JAY STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
44335
KY
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
112139
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007276600
—
FL
01
—
1013189877
TRICARE
FL
01
—
14MV1
BCBS
FL
Enumeration date
04/01/2008
Last updated
07/11/2013
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