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General NPI Number Information
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NPI Number | 1891290391
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Entity Type | Individual
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Provider Name | JULIE TAYLOR TYREE MD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 1801 ASHLEY CIRCLE BOWLING GREEN, KY 42104
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City | BOWLING GREEN
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State | KY
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Zip | 42101-4210
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Country | US
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Telephone | 270-793-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 5380 TECH DATA DR STE 202
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City | CLEARWATER
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State | FL
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Zip | 33760-3122
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Country | US
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Telephone | 727-507-3609
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 56489
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License Number State | KY
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