Provider Demographics
NPI:1649373846
Name:GUTMAN, TRACY EMILY (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:EMILY
Last Name:GUTMAN
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 1:9927 N DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2819
Mailing Address - Country:US
Mailing Address - Phone:573-289-2626
Mailing Address - Fax:
Practice Address - Street 1:150 BEAVERCREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4302
Practice Address - Country:US
Practice Address - Phone:503-742-5300
Practice Address - Fax:503-655-8293
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
ORMD160251207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Yes174H00000XOther Service ProvidersHealth Educator