Provider Demographics
NPI:1427368448
Name:JOHNSON, TRACY LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1 JARRETT WHITE ROAD
Mailing Address - Street 2:TRIPLER ARMY MEDICAL CENTER
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96859
Mailing Address - Country:US
Mailing Address - Phone:808-433-2539
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:TRIPLER ARMY MEDICAL CENTER
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258418208D00000X
HIDOS-1406208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice