Provider Demographics
NPI:1417901828
Name:DRUMMOND, TRACEY D (MD)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:D
Last Name:DRUMMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10565 N 114TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4942
Mailing Address - Country:US
Mailing Address - Phone:480-621-3505
Mailing Address - Fax:480-621-3506
Practice Address - Street 1:10565 N 114TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4942
Practice Address - Country:US
Practice Address - Phone:480-621-3505
Practice Address - Fax:480-621-3506
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20658208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics