Provider Demographics
NPI:1023028172
Name:SLOCUM FARRITOR, TRACY L (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:SLOCUM FARRITOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:SLOCUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:555 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2462
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:555 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2462
Practice Address - Country:US
Practice Address - Phone:402-219-8747
Practice Address - Fax:402-219-8748
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100380190AMedicaid
NE76-00114OtherUHC
IA0587493Medicaid
NE04399OtherBCBS
NE470780857 23Medicaid
10422OtherMIDLANDS CHOICE
10422OtherMIDLANDS CHOICE