Provider Demographics
NPI:1245674340
Name:WHITE, TRACY LYNETTE (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNETTE
Last Name:WHITE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2006
Mailing Address - Country:US
Mailing Address - Phone:510-981-4100
Mailing Address - Fax:510-981-4294
Practice Address - Street 1:2031 6TH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2006
Practice Address - Country:US
Practice Address - Phone:510-981-4100
Practice Address - Fax:510-981-4294
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132938207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program