Provider Demographics
NPI:1497821318
Name:BELL, TRACY L (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:BELL
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 1:7011 LINDA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6307
Mailing Address - Country:US
Mailing Address - Phone:858-810-8763
Mailing Address - Fax:
Practice Address - Street 1:7011 LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6307
Practice Address - Country:US
Practice Address - Phone:858-810-8763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29801207Q00000X
CAG188438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1111898Medicaid
IA04396Medicare PIN
IAE66593Medicare UPIN