Provider Demographics
NPI:1962447128
Name:CONRAD, TRACY HELENE (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:HELENE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 56958
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-1958
Mailing Address - Country:US
Mailing Address - Phone:818-907-7908
Mailing Address - Fax:818-907-5109
Practice Address - Street 1:412 W TAHQUITZ CANYON WAY
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5649
Practice Address - Country:US
Practice Address - Phone:760-963-2608
Practice Address - Fax:760-323-4452
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG069410207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF29623Medicare UPIN