Provider Demographics
NPI:1740341544
Name:ROBERTS, TRACY J (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:J
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-1575
Mailing Address - Fax:850-416-1302
Practice Address - Street 1:5153 N 9TH AVE
Practice Address - Street 2:PEDIATRIC OFFICE BUILDING
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8785
Practice Address - Country:US
Practice Address - Phone:850-416-1575
Practice Address - Fax:850-416-1302
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN6923207X00000X
FLME104897207XS0117X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001050400Medicaid
FL001050400Medicaid