Provider Demographics
NPI:1891290391
Name:TYREE, JULIE TAYLOR (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:TAYLOR
Last Name:TYREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 TECH DATA DR STE 202
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3122
Mailing Address - Country:US
Mailing Address - Phone:727-507-3609
Mailing Address - Fax:
Practice Address - Street 1:1801 ASHLEY CIRCLE
Practice Address - Street 2:BOWLING GREEN, KY 42104
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4210
Practice Address - Country:US
Practice Address - Phone:270-793-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY56489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine