Tracy, Tracey Kathleen

Tracy, Tracey Kathleen is an individual health care provider with primary practice located at 506 4Th St , La Grande OR 97850. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Tracy, Tracey Kathleen can be contacted via phone (541) 663-3138.

Contact Information

Primary practice address
506 4Th St La Grande OR 97850
Phone: (541) 663-3138
Fax: (541) 975-5120
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD151037 Oregon
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD60747878 Washington

Profile Details

NPI number 1073760955
LBN Legal business name Tracy, Tracey Kathleen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 22nd, 2008
Last updated Apr 5th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073760955 NPPES
Oregon MEDICAID 500620109
Oregon Other P00965892

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