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General NPI Number Information
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NPI Number | 1215126206
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Entity Type | Organization
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Legal Business Name | W. CRAIG TYREE, MD, PLC
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 103 TRISTA LN
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City | GLASGOW
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State | KY
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Zip | 42141-3482
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Country | US
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Telephone | 270-659-0184
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Fax | 270-651-9264
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Provider Business Mailing Address
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Address Line | PO BOX 416
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City | GLASGOW
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State | KY
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Zip | 42142-0416
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Country | US
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Telephone | 270-659-0184
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Fax | 270-651-9264
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | WILLIAM CRAIG TYREE
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Credential | MD
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Telephone | 270-659-0184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 34721
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License Number State | KY
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