MEDICARE: DR. WILLIAM CRAIG TYREE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	34721	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000364528	OTHER	KY	ANTHEM INDIVIDUAL PIN NUM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205835683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM CRAIG TYREE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 416
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42142-0416
Country	:	US
Telephone Number	:	270-659-0184
Fax Number	:	270-651-9264

Provider Business Practice Location Address
First Line	:	103 TRISTA LN
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-3482
Country	:	US
Telephone Number	:	270-659-0184
Fax Number	:	270-651-9264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	05/21/2012

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