Individual
DR. ROBERT FENTON TYREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5955 ZEAMER AVE, JBER, AK 99506-3702
(740) 708-9705
(888) 369-9682
Mailing address
5955 ZEAMER AVENUE, JOINT BASE ELMENDORF-RICHARDSON, AK 99506
(740) 708-9705
(888) 369-9682
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
31621
WI
207Q00000X
Family Medicine Physician
Primary
35-06-4727-T
OH
207Q00000X
Family Medicine Physician
7690
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000538559
ANTHEM
OH
01
—
01-04353
UHC
OH
05
—
0213254
—
OH
01
—
2017149
AETNA
OH
01
—
314379443
KLAIS
OH
01
—
314379443-159
CENTRAL BENEFITS
OH
01
—
9327536-001
CIGNA
OH
Enumeration date
05/28/2005
Last updated
11/21/2013
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