Elam, Tyler J.

Elam, Tyler J. is an individual health care provider with primary practice located at 645 Interstate Dr , Grayson KY 41143-1704. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Elam, Tyler J. can be contacted via phone (606) 474-0669.

Contact Information

Primary practice address
645 Interstate Dr Grayson KY 41143-1704
Phone: (606) 474-0669
Fax: (606) 474-0376
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 04118 Kentucky

Profile Details

NPI number 1144646209
LBN Legal business name Elam, Tyler J.
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 13th, 2014
Last updated Jul 21st, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144646209 NPPES
Kentucky Other K247850 MEDICARE MMS
Kentucky Other 04118 MEDICARE MMS
Kentucky MEDICAID 7100472630 MEDICARE MMS

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