Provider Demographics
NPI:1124212865
Name:WINTERS, TYREE MS (DO)
Entity Type:Individual
Prefix:DR
First Name:TYREE
Middle Name:MS
Last Name:WINTERS
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:405 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9340
Mailing Address - Country:US
Mailing Address - Phone:856-582-0033
Mailing Address - Fax:856-582-2305
Practice Address - Street 1:405 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9340
Practice Address - Country:US
Practice Address - Phone:856-582-0033
Practice Address - Fax:856-582-2305
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009546208000000X
NJ25MB09747200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0052568Medicaid