Provider Demographics
NPI:1770528457
Name:BRACY, MARC STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:STEVEN
Last Name:BRACY
Suffix:
Gender:M
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 661972
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1972
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:1133 W SYCAMORE STREET
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988
Practice Address - Country:US
Practice Address - Phone:530-934-1800
Practice Address - Fax:530-934-1865
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77398207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G773980Medicaid
CA00G773980Medicaid
F66563Medicare UPIN