Provider Demographics
NPI:1003848763
Name:TRACY, ROBERT N (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:TRACY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-781-4111
Mailing Address - Fax:859-441-5214
Practice Address - Street 1:413 SOUTH LOOP ROAD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5446
Practice Address - Country:US
Practice Address - Phone:859-301-3800
Practice Address - Fax:859-301-3987
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0101286Medicaid
KY080092534OtherRAILROAD MEDICARE
KYP00839856OtherRAILROAD MEDICARE
KY64266182Medicaid
OH0101286Medicaid
KY64266182Medicaid
KY008580061Medicare PIN