Provider Demographics
NPI:1033228986
Name:LAFLAIR, TRACY LYNN (MD)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:LAFLAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4496
Mailing Address - Country:US
Mailing Address - Phone:315-393-0797
Mailing Address - Fax:315-393-0529
Practice Address - Street 1:1107 LINDEN ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-4496
Practice Address - Country:US
Practice Address - Phone:315-393-0797
Practice Address - Fax:315-393-0529
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01925162Medicaid
NYP00149682OtherPALMETTO (MCR) RR
G92102Medicare UPIN
NYP00149682OtherPALMETTO (MCR) RR