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Individual

TYLER JAY STALEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
350 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2733
(386) 238-3290
(386) 238-3278
Mailing address
PO BOX 9671, DAYTONA BEACH, FL 32120-9671
(386) 676-7130
(386) 676-7125

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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