Provider Demographics
NPI:1992022776
Name:GRAHAM, TRACY MARIA (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MARIA
Last Name:GRAHAM
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 1:1300 MICCOSUKEE ROAD
Mailing Address - Street 2:BIXLER EMERGENCY CENTER
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-431-0911
Mailing Address - Fax:850-431-0779
Practice Address - Street 1:1300 MICCOSUKEE ROAD
Practice Address - Street 2:BIXLER EMERGENCY CENTER
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-431-0911
Practice Address - Fax:850-431-0779
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN14663207P00000X
FLME115260207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine