Provider Demographics
NPI:1043252810
Name:BUTCHER, TRACEY ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:ELLEN
Last Name:BUTCHER
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 1:1004 1ST ST N STE 370
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8605
Mailing Address - Country:US
Mailing Address - Phone:205-663-5547
Mailing Address - Fax:
Practice Address - Street 1:1004 1ST ST N STE 370
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8605
Practice Address - Country:US
Practice Address - Phone:205-663-5547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22829208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC57-1004971024OtherBCBS OF SC
SC7073602OtherAETNA
SC228293Medicaid
SCH859417951Medicare PIN
SC57-1004971024OtherBCBS OF SC