Provider Demographics
NPI:1003170325
Name:LAWYER, TRACYE JEAN-MARIE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:TRACYE
Middle Name:JEAN-MARIE
Last Name:LAWYER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 W EMERALD ST STE 168
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8296
Mailing Address - Country:US
Mailing Address - Phone:208-871-6871
Mailing Address - Fax:208-871-6871
Practice Address - Street 1:8950 W EMERALD ST STE 168
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8296
Practice Address - Country:US
Practice Address - Phone:208-321-1209
Practice Address - Fax:208-321-1211
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM14247207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSRES000Medicare UPIN