Provider Demographics
NPI:1255520599
Name:TREECE, YVONNE PERLE (MD)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:PERLE
Last Name:TREECE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:PERLE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 S 11TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4880
Mailing Address - Country:US
Mailing Address - Phone:208-323-7862
Mailing Address - Fax:208-232-7862
Practice Address - Street 1:500 S 11TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4878
Practice Address - Country:US
Practice Address - Phone:208-232-7862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43055174400000X
MO2008013988207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPPLIEDMedicaid
TNAPPLIEDMedicaid
MO30010991Medicare PIN