Staley, Tyler Jay
Staley, Tyler Jay is an individual health care provider with primary practice located at 350 N Clyde Morris Blvd , Daytona Beach FL 32114-2733. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Staley, Tyler Jay can be contacted via phone (386) 238-3290.Contact Information
Primary practice address
350 N Clyde Morris Blvd
Daytona Beach FL 32114-2733
Phone: (386) 238-3290
Fax: (386) 238-3278
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation | 208100000X | 44335 | Kentucky |
| Allopathic & Osteopathic Physicians / Sports Medicine | 2081S0010X | 112139 | Florida |
Profile Details
| NPI number | 1013189877 |
|---|---|
| LBN Legal business name | Staley, Tyler Jay |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 1st, 2008 |
| Last updated | Jul 11th, 2013 - about 12 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1013189877 | NPPES |
| Florida | Other | 1013189877 | TRICARE |
| Florida | MEDICAID | 007276600 | TRICARE |
| Florida | Other | 14MV1 | TRICARE |
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