Provider Demographics
NPI:1639160468
Name:BIEDIGER, TRACY LEE (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:BIEDIGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26871 NELSON HL
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5232
Mailing Address - Country:US
Mailing Address - Phone:210-698-1929
Mailing Address - Fax:210-698-1929
Practice Address - Street 1:MCHE-QD/CREDENTIALS
Practice Address - Street 2:3851 ROGER BROOKE DRIVE
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-916-2481
Practice Address - Fax:210-916-3103
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8915207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology