Provider Demographics
NPI:1073541587
Name:TRACY, PATRICK LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LLOYD
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 1:2512 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19245 7TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7504
Practice Address - Country:US
Practice Address - Phone:360-782-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080046467OtherRAILROAD MEDICARE
5924017OtherAETNA
WA49127OtherLABOR & INDUSTRIES
TR0082OtherREGENCE BLUESHIELD
WA8150674Medicaid
WA8150674Medicaid
WAG115136442Medicare PIN
WAGAB05226Medicare PIN
G8878998Medicare PIN
WAG000250604Medicare PIN
WA49127OtherLABOR & INDUSTRIES
AT9019630OtherDEA
TR0082OtherREGENCE BLUESHIELD
WAG8852208Medicare PIN
WAG000250442Medicare PIN