Provider Demographics
NPI:1639126626
Name:FERRAGAMO, TRACY C (DPM)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:C
Last Name:FERRAGAMO
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 1:2925 SPAFFORD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6808
Mailing Address - Country:US
Mailing Address - Phone:530-753-9080
Mailing Address - Fax:530-753-9085
Practice Address - Street 1:2925 SPAFFORD ST
Practice Address - Street 2:SUITE A
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6808
Practice Address - Country:US
Practice Address - Phone:530-753-9080
Practice Address - Fax:530-753-9085
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE37620213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU23783Medicare UPIN
CA6010440001Medicare NSC
CA000E37620Medicare ID - Type Unspecified