Provider Demographics
NPI:1548427875
Name:EVANS, TRACY BIALY (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:BIALY
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:BIALY
Other - Last Name:BRAMLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-202-1540
Mailing Address - Fax:415-202-0189
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-202-1540
Practice Address - Fax:415-202-0189
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96572207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology