Healthcare Provider Details

I. General information

NPI: 1245610062
Provider Name (Legal Business Name): CHRISTOPHER TYREE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2015
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W EVANS ST
FLORENCE SC
29501
US

IV. Provider business mailing address

1730 SAINT JULIAN PL
COLUMBIA SC
29204-2410
US

V. Phone/Fax

Practice location:
  • Phone: 843-665-4567
  • Fax:
Mailing address:
  • Phone: 803-256-6776
  • Fax: 803-256-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number668
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: