Provider Demographics
NPI:1942202718
Name:ELLIOTT, TRACY HAYMANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:HAYMANN
Last Name:ELLIOTT
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 1:555 REPUBLIC DR
Mailing Address - Street 2:SUITE #460
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5481
Mailing Address - Country:US
Mailing Address - Phone:972-644-2819
Mailing Address - Fax:972-680-2949
Practice Address - Street 1:4401 COIT RD
Practice Address - Street 2:SUITE # 205
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0500
Practice Address - Country:US
Practice Address - Phone:972-377-6553
Practice Address - Fax:972-377-6453
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4362207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150768301Medicaid
TX150768301Medicaid
TX8708K2Medicare ID - Type Unspecified