Provider Demographics
NPI:1083808885
Name:REECE, TRACY MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MARTIN
Last Name:REECE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:MARTY
Other - Middle Name:
Other - Last Name:REECE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:611 TOLL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5283
Mailing Address - Country:US
Mailing Address - Phone:423-773-9721
Mailing Address - Fax:423-743-2884
Practice Address - Street 1:611 TOLL BRANCH RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-5283
Practice Address - Country:US
Practice Address - Phone:423-773-9721
Practice Address - Fax:423-743-2884
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2011207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100078890Medicaid
TN1511260Medicaid
KY7100078890Medicaid