Provider Demographics
NPI:1053313676
Name:KVARFORDT, TRACY D (M D)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:D
Last Name:KVARFORDT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 S 1470 E STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1762
Mailing Address - Country:US
Mailing Address - Phone:435-674-0999
Mailing Address - Fax:435-674-0960
Practice Address - Street 1:295 S 1470 E STE 300
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1762
Practice Address - Country:US
Practice Address - Phone:435-674-0999
Practice Address - Fax:435-674-0960
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6068207V00000X
UT61169401205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE81414Medicare UPIN
UT000061639Medicare PIN