Provider Demographics
NPI:1851582282
Name:TRACY, THOMAS LYMAN BURN (MA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LYMAN BURN
Last Name:TRACY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 WILLOW PASS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5225
Mailing Address - Country:US
Mailing Address - Phone:925-825-1793
Mailing Address - Fax:
Practice Address - Street 1:1333 WILLOW PASS RD STE 102
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5225
Practice Address - Country:US
Practice Address - Phone:925-825-1793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program