Individual
TYLER ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
15 EXCHANGE DR, LUGOFF, SC 29078-9198
(803) 670-8238
Mailing address
15 EXCHANGE DR, LUGOFF, SC 29078-9198
(803) 670-8238
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
4796
SC
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/12/2020
Last updated
05/02/2023
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