Provider Demographics
NPI:1639303852
Name:TRACY, JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:TRACY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1750 THOMPSON RD
Mailing Address - Street 2:#106
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2100
Mailing Address - Country:US
Mailing Address - Phone:541-269-0333
Mailing Address - Fax:541-267-6905
Practice Address - Street 1:817 S UNIVERSITY DR
Practice Address - Street 2:#106
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3309
Practice Address - Country:US
Practice Address - Phone:954-723-0334
Practice Address - Fax:954-723-0807
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
282N00000X
FLUO4175207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No282N00000XHospitalsGeneral Acute Care Hospital