Provider Demographics
NPI:1255395109
Name:ANGELOCCI, TRACY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LYNN
Last Name:ANGELOCCI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:205 E UNIVERSITY AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6814
Mailing Address - Country:US
Mailing Address - Phone:512-686-1124
Mailing Address - Fax:512-868-9894
Practice Address - Street 1:500 W WHITESTONE BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2245
Practice Address - Country:US
Practice Address - Phone:512-250-3900
Practice Address - Fax:512-249-6563
Is Sole Proprietor?:No
Enumeration Date:2006-04-15
Last Update Date:2015-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK1342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0072Medicare ID - Type Unspecified
TXG17989Medicare UPIN