Healthcare Provider Details

I. General information

NPI: 1891290391
Provider Name (Legal Business Name): JULIE TAYLOR TYREE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 07/22/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ASHLEY CIRCLE BOWLING GREEN, KY 42104
BOWLING GREEN KY
42101-4210
US

IV. Provider business mailing address

5380 TECH DATA DR STE 202
CLEARWATER FL
33760-3122
US

V. Phone/Fax

Practice location:
  • Phone: 270-793-1000
  • Fax:
Mailing address:
  • Phone: 727-507-3609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number56489
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: