Provider Demographics
NPI:1912178526
Name:COLUMB, TRACEY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:MARIE
Last Name:COLUMB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:MARIE
Other - Last Name:GUILDENBECHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:827 NE 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4337
Mailing Address - Country:US
Mailing Address - Phone:503-927-5574
Mailing Address - Fax:
Practice Address - Street 1:700 KATLIAN ST
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7359
Practice Address - Country:US
Practice Address - Phone:907-747-5861
Practice Address - Fax:907-747-5415
Is Sole Proprietor?:No
Enumeration Date:2008-03-23
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK6821OtherSTATE LICENSE
AKMD1196Medicaid
AK6821OtherSTATE LICENSE