Individual
TYLER J. ELAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
645 INTERSTATE DR, GRAYSON, KY 41143-1704
(606) 474-0669
(606) 474-0376
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(606) 330-7835
(859) 744-1177
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04118
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04118
STATE MEDICAL LICENSE
KY
05
—
7100472630
—
KY
01
—
K247850
MEDICARE MMS
KY
Enumeration date
03/13/2014
Last updated
09/24/2025
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