Provider Demographics
NPI:1770589491
Name:MARTIN, TRACEY L (MD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4515 S MCCLINTOCK DR
Mailing Address - Street 2:STE 100
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7381
Mailing Address - Country:US
Mailing Address - Phone:480-820-1133
Mailing Address - Fax:480-820-9292
Practice Address - Street 1:4515 S MCCLINTOCK DR
Practice Address - Street 2:STE 100
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7381
Practice Address - Country:US
Practice Address - Phone:480-820-1133
Practice Address - Fax:480-820-9292
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2011-02-11
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Provider Licenses
StateLicense IDTaxonomies
AZ27302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H03864Medicare UPIN
AZ72000Medicare ID - Type Unspecified