Provider Demographics
NPI:1013952555
Name:LACY, TRACI T (MD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:T
Last Name:LACY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:TRI
Other - Last Name:BRUMUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7373 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4326
Mailing Address - Country:US
Mailing Address - Phone:225-769-4044
Mailing Address - Fax:
Practice Address - Street 1:7373 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4326
Practice Address - Country:US
Practice Address - Phone:225-769-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14013R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1187496Medicaid