Provider Demographics
NPI:1346283835
Name:TRACY, RYAN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PATRICK
Last Name:TRACY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2299 BACON ST STE 7
Mailing Address - Street 2:STE. 110
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2046
Mailing Address - Country:US
Mailing Address - Phone:925-676-6500
Mailing Address - Fax:925-676-2771
Practice Address - Street 1:2299 BACON ST STE 7
Practice Address - Street 2:STE. 110
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2046
Practice Address - Country:US
Practice Address - Phone:925-676-6500
Practice Address - Fax:925-676-2771
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83635174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist