Provider Demographics
NPI:1114964590
Name:MUIRHEID, TRACI DENISE (PA)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:DENISE
Last Name:MUIRHEID
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 HEDGCOXE DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3104
Mailing Address - Country:US
Mailing Address - Phone:972-801-3600
Mailing Address - Fax:972-801-3698
Practice Address - Street 1:2100 HEDGCOXE DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-3104
Practice Address - Country:US
Practice Address - Phone:972-801-3600
Practice Address - Fax:972-801-3698
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02008363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L4648Medicare PIN
TX8L4651Medicare PIN
TX83N205Medicare ID - Type Unspecified
TX8L4645Medicare PIN
TXS89206Medicare UPIN