Provider Demographics
NPI:1821049446
Name:METCALFE, TRACEE L (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACEE
Middle Name:L
Last Name:METCALFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 40000
Mailing Address - Street 2:AMY FARNELL
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658-7520
Mailing Address - Country:US
Mailing Address - Phone:970-390-6449
Mailing Address - Fax:970-926-6348
Practice Address - Street 1:181 W MEADOW DR
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-5242
Practice Address - Country:US
Practice Address - Phone:970-390-6449
Practice Address - Fax:970-479-7282
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA45353207R00000X
CO44719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06874355Medicaid
CO805682Medicare PIN
CO06874355Medicaid