Provider Demographics
NPI:1407237225
Name:TOMMACK, TRACY (DVM)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:TOMMACK
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 THOUSAND OAKS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3968
Mailing Address - Country:US
Mailing Address - Phone:210-495-8245
Mailing Address - Fax:210-495-1972
Practice Address - Street 1:2250 THOUSAND OAKS DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3968
Practice Address - Country:US
Practice Address - Phone:210-495-8245
Practice Address - Fax:210-495-1972
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8621174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian