Provider Demographics
NPI:1285828558
Name:TRACY M REED, DPM,LLC
Entity Type:Organization
Organization Name:TRACY M REED, DPM,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-381-2224
Mailing Address - Street 1:5937 W FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-4952
Mailing Address - Country:US
Mailing Address - Phone:314-381-2224
Mailing Address - Fax:314-381-1771
Practice Address - Street 1:5937 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-4952
Practice Address - Country:US
Practice Address - Phone:314-381-2224
Practice Address - Fax:314-381-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000797213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4810960001OtherMEDICAID DMERC
MOU76681Medicare UPIN