Active NPI
Tyler Dewayne Roley
- Physical Medicine & Rehabilitation Physician
- Jay, FL
National Provider Identifier
1528619004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 34638
- Practice address
- 14114 Alabama St
Jay, FL 32565-1219 - Phone
- (850) 675-8040
- Fax
- (850) 675-8016
- NPI assigned
- Sep 25, 2019
- Last updated
- Sep 25, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 34638 | FL | Primary |
Addresses
Primary practice location
14114 Alabama St
Jay, FL 32565-1219
Mailing address
14114 Alabama St
Jay, FL 32565-1219
Phone (850) 675-8040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34638 | FL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569369600000",
"number": "1528619004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14114 ALABAMA ST",
"city": "JAY",
"state": "FL",
"postal_code": "325651219",
"telephone_number": "850-675-8040",
"fax_number": "850-675-8016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14114 ALABAMA ST",
"city": "JAY",
"state": "FL",
"postal_code": "325651219",
"telephone_number": "850-675-8040",
"fax_number": "850-675-8016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROLEY",
"first_name": "TYLER",
"middle_name": "DEWAYNE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-25",
"last_updated": "2019-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "FL",
"license": "34638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jay, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.