Provider Demographics
NPI:1275515223
Name:MERRELL, TRACY ALAN (DPM)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ALAN
Last Name:MERRELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 S CHURCH ST
Mailing Address - Street 2:STE A100
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-4958
Mailing Address - Country:US
Mailing Address - Phone:615-848-1902
Mailing Address - Fax:615-848-0721
Practice Address - Street 1:1747 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2563
Practice Address - Country:US
Practice Address - Phone:615-848-1902
Practice Address - Fax:615-848-0721
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000484213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4038849OtherBCBS
TN4663010001OtherPALMETTO
TN3352573Medicaid
TN3352573Medicaid
TN4038849OtherBCBS