Provider Demographics
NPI:1790762185
Name:WEST, TRACY J (DO)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:J
Last Name:WEST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:JEAN
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:649 S 30TH CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-3119
Mailing Address - Country:US
Mailing Address - Phone:480-227-5514
Mailing Address - Fax:480-502-2430
Practice Address - Street 1:649 S 30TH CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-3119
Practice Address - Country:US
Practice Address - Phone:480-227-5514
Practice Address - Fax:480-502-2430
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4236207P00000X, 207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ118140OtherPTAN
AZ118139OtherGROUP PTAN
AZ1245423524OtherGROUP NPI
G79479Medicare UPIN