Provider Demographics
NPI:1083761142
Name:GEORGE, TRACY IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:IRENE
Last Name:GEORGE
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:UNIVERSITY OF UTAH
Mailing Address - Street 2:50 N MEDICAL DR
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:87132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF UTAH 50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:505-272-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20120889207ZH0000X, 207ZP0102X
UT10552861-1205207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD.207588OtherLOUISIANA MEDICAL LICENSE
NMMD2012-0889OtherNEW MEXICO MEDICAL BOARD LICENSE
NV14173OtherNEVADA MEDICAL LICENSE
CAA62223OtherCALIFORNIA PHYSICIAN AND SURGEON LICENSE
FLME 118408OtherFLORIDA MEDICAL LICENSE
FLME 118408OtherFLORIDA MEDICAL LICENSE