Provider Demographics
NPI:1356436836
Name:OPPENHEIM, TRACEY S (MD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:S
Last Name:OPPENHEIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E. SOUTHERN AVE
Mailing Address - Street 2:STE. 735
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2692
Mailing Address - Country:US
Mailing Address - Phone:480-804-0326
Mailing Address - Fax:480-804-0083
Practice Address - Street 1:2120 S MCCLINTOCK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2692
Practice Address - Country:US
Practice Address - Phone:480-804-0326
Practice Address - Fax:480-804-0083
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ357332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ133643Medicaid
Z111434Medicare PIN
AZZ136933Medicare PIN
AZ133643Medicaid
Z115646Medicare PIN