Provider Demographics
NPI:1508024753
Name:STREVEY, TRACY ELMER JR (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ELMER
Last Name:STREVEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 WOODGATE DR
Mailing Address - Street 2:
Mailing Address - City:FRONTENAC
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4724
Mailing Address - Country:US
Mailing Address - Phone:314-966-1044
Mailing Address - Fax:314-966-7720
Practice Address - Street 1:1509 WOODGATE DR
Practice Address - Street 2:
Practice Address - City:FRONTENAC
Practice Address - State:MO
Practice Address - Zip Code:63131-4724
Practice Address - Country:US
Practice Address - Phone:314-966-1044
Practice Address - Fax:314-966-7720
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007001270208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)