Provider Demographics
NPI:1437142619
Name:DUNCAN, TRACY DIANNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:DIANNE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-2407
Mailing Address - Country:US
Mailing Address - Phone:870-763-2326
Mailing Address - Fax:870-763-2646
Practice Address - Street 1:511 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2407
Practice Address - Country:US
Practice Address - Phone:870-763-2326
Practice Address - Fax:870-763-2646
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR142213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU49974Medicare UPIN