Provider Demographics
NPI:1902821812
Name:JAMES F TRACY DPM PA
Entity Type:Organization
Organization Name:JAMES F TRACY DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-552-5545
Mailing Address - Street 1:10860 SW 88TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2680
Mailing Address - Country:US
Mailing Address - Phone:305-552-5545
Mailing Address - Fax:305-552-0156
Practice Address - Street 1:10860 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2680
Practice Address - Country:US
Practice Address - Phone:305-552-5545
Practice Address - Fax:305-552-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2268213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340522200Medicaid
FL94882OtherBCBS OF FL
FLK7424Medicare PIN