Provider Demographics
NPI:1225031768
Name:TYREE, ROBERT FENTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FENTON
Last Name:TYREE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 ZEAMER AVENUE
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE ELMENDORF-RICHARDSON
Mailing Address - State:AK
Mailing Address - Zip Code:99506
Mailing Address - Country:US
Mailing Address - Phone:740-708-9705
Mailing Address - Fax:888-369-9682
Practice Address - Street 1:5955 ZEAMER AVE
Practice Address - Street 2:
Practice Address - City:JBER
Practice Address - State:AK
Practice Address - Zip Code:99506-3702
Practice Address - Country:US
Practice Address - Phone:740-708-9705
Practice Address - Fax:888-369-9682
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-4727-T207Q00000X
WI31621207Q00000X
AK7690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01-04353OtherUHC
OH000000538559OtherANTHEM
OH0213254Medicaid
OH9327536-001OtherCIGNA
OH2017149OtherAETNA
OH314379443OtherKLAIS
OH314379443-159OtherCENTRAL BENEFITS
OH000000538559OtherANTHEM
OH314379443OtherKLAIS