Provider Demographics
NPI:1114111069
Name:TRACY KVARFORDT MD PC
Entity Type:Organization
Organization Name:TRACY KVARFORDT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:KVARFORDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-674-0999
Mailing Address - Street 1:515 S 300 E STE 205
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3979
Mailing Address - Country:US
Mailing Address - Phone:435-674-0999
Mailing Address - Fax:435-674-0960
Practice Address - Street 1:515 S 300 E STE 205
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3979
Practice Address - Country:US
Practice Address - Phone:435-674-0999
Practice Address - Fax:435-674-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT611694-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty