Provider Demographics
NPI:1295831154
Name:TORBERT, TRACI L (DO)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:TORBERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 EL CAMPO AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4513
Mailing Address - Country:US
Mailing Address - Phone:817-874-6605
Mailing Address - Fax:
Practice Address - Street 1:2801 FRANCISCAN DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2544
Practice Address - Country:US
Practice Address - Phone:979-776-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4598207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183394916Medicaid
TX8X7670OtherBCBS
TX183394915Medicaid
TX183394903Medicaid
TX8V1549OtherBCBS
TX183394904Medicaid
TX183394902Medicaid
TX183394909Medicaid
TX8S6623OtherBCBS
TX183394906Medicaid
TX8BX429OtherBCBS OF TX
TX8X7457OtherBCBS
TX8S6623OtherBCBS
TXI67391Medicare UPIN
TX183394903Medicaid
TX183394902Medicaid
TX8J2751Medicare PIN
TX8X7670OtherBCBS
TX8BX429OtherBCBS OF TX
TX183394904Medicaid
TX183394915Medicaid
TX8J2750Medicare PIN