Provider Demographics
NPI:1235101502
Name:TRACY, HEATHER JENE (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:JENE
Last Name:TRACY
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:NMCSD, ATTN: MEDICAL STAFF SERVICES
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:619-532-7300
Mailing Address - Fax:619-532-6299
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:NMCSD, ATTN: MEDICAL STAFF SERVICES
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-532-6460
Practice Address - Fax:619-532-6299
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101237223207R00000X
AZ68599207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVODOOMedicare UPIN