Provider Demographics
NPI:1225478019
Name:SNOW MILLS, TRACY JO (DO)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:JO
Last Name:SNOW MILLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:JO
Other - Last Name:SNOW ALLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 SAINT MICHAEL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5211
Mailing Address - Country:US
Mailing Address - Phone:903-614-5372
Mailing Address - Fax:903-614-5343
Practice Address - Street 1:14725 COMPASS ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6203
Practice Address - Country:US
Practice Address - Phone:361-902-6170
Practice Address - Fax:361-902-6191
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS1748207Q00000X
390200000X
TXQ9250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1M8600OtherMEDICARE
TX421274801Medicaid
TXPENDINGMedicaid