Provider Demographics
NPI:1639307101
Name:DR. TRACY A. MERRELL, D.P.M., P.C.
Entity Type:Organization
Organization Name:DR. TRACY A. MERRELL, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:615-848-1902
Mailing Address - Street 1:1747 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2563
Mailing Address - Country:US
Mailing Address - Phone:615-848-1902
Mailing Address - Fax:
Practice Address - Street 1:1747 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2563
Practice Address - Country:US
Practice Address - Phone:615-848-1902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN484213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty