Provider Demographics
NPI:1255835070
Name:WADSWORTH, TRACY (MD, MS)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:WADSWORTH ROHRBACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MS
Mailing Address - Street 1:5009 NEZ PERCE WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5372
Mailing Address - Country:US
Mailing Address - Phone:951-312-2702
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program