Provider Demographics
NPI:1447203229
Name:AYERS, TRACY E (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:E
Last Name:AYERS
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 1:302 MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4346
Mailing Address - Country:US
Mailing Address - Phone:252-247-2013
Mailing Address - Fax:252-247-7299
Practice Address - Street 1:302 MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4346
Practice Address - Country:US
Practice Address - Phone:252-247-2013
Practice Address - Fax:252-247-7299
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63470217Medicaid
CO317239YKRDMedicare UPIN
COG56551Medicare UPIN