Provider Demographics
NPI:1003824715
Name:TRACEY H STOKES MD PA
Entity Type:Organization
Organization Name:TRACEY H STOKES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-463-5208
Mailing Address - Street 1:717 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3605
Mailing Address - Country:US
Mailing Address - Phone:954-463-5208
Mailing Address - Fax:954-463-5288
Practice Address - Street 1:717 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3605
Practice Address - Country:US
Practice Address - Phone:954-463-5208
Practice Address - Fax:954-463-5288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8557Medicare ID - Type Unspecified
FLI42848Medicare UPIN