Provider Demographics
NPI:1689142127
Name:TRACY BYERLY II , MD PA
Entity Type:Organization
Organization Name:TRACY BYERLY II , MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER/SURGERY SCHEDULER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-997-4000
Mailing Address - Street 1:1217 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4019
Mailing Address - Country:US
Mailing Address - Phone:830-997-4000
Mailing Address - Fax:830-997-2028
Practice Address - Street 1:205 W WINDCREST ST STE 210
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4480
Practice Address - Country:US
Practice Address - Phone:830-997-4000
Practice Address - Fax:830-997-2028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRACY BYERLY II, MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1427354208OtherBCBS