Provider Demographics
NPI:1205140027
Name:FREEBORN, TRACY LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LYNN
Last Name:FREEBORN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:ZEILINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2320 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1303
Mailing Address - Country:US
Mailing Address - Phone:602-258-9900
Mailing Address - Fax:602-258-9904
Practice Address - Street 1:9321 W THOMAS RD STE 325
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3396
Practice Address - Country:US
Practice Address - Phone:623-936-5406
Practice Address - Fax:623-936-5479
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006728208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ038029Medicaid