Provider Demographics
NPI:1790771442
Name:BASER-DECKER, TRACY (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BASER-DECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 W ORANGE GROVE RD STE 302
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1152
Mailing Address - Country:US
Mailing Address - Phone:520-797-3888
Mailing Address - Fax:520-797-2196
Practice Address - Street 1:1925 W ORANGE GROVE RD STE 302
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1152
Practice Address - Country:US
Practice Address - Phone:520-797-3888
Practice Address - Fax:520-797-2196
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ25513208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ497562Medicaid