Provider Demographics
NPI:1346222452
Name:LE, TRAC T (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAC
Middle Name:T
Last Name:LE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4409 UTICA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-457-3687
Mailing Address - Fax:504-620-0250
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE N511
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-6301
Practice Address - Fax:504-349-6308
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA022297207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1480401Medicaid
LA5A360Medicare ID - Type Unspecified
LA1480401Medicaid