Provider Demographics
NPI:1275592925
Name:NEAL, TRACY D (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:D
Last Name:NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 VETERANS MEMORIAL DRIVE
Mailing Address - Street 2:BUILDING 163, 2D-102
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504
Mailing Address - Country:US
Mailing Address - Phone:254-743-1439
Mailing Address - Fax:
Practice Address - Street 1:1901 VETERANS MEMORIAL DRIVE
Practice Address - Street 2:BUILDING 163, 2D-102
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-743-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK136281207L00000X
TXJ8006207L00000X
IN01078142A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118929202Medicaid
TX86855KMedicare ID - Type Unspecified