Provider Demographics
NPI:1770593550
Name:FITZHUGH, TRACI N (MD)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:N
Last Name:FITZHUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:N
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2545 W FRYE RD STE 9
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6273
Mailing Address - Country:US
Mailing Address - Phone:480-505-4258
Mailing Address - Fax:480-505-3689
Practice Address - Street 1:6301 S MCCLINTOCK DR STE 215
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3394
Practice Address - Country:US
Practice Address - Phone:480-820-6657
Practice Address - Fax:480-730-0803
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD67627207V00000X
AZ50591207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ068693Medicaid
MDD67627OtherSTATE MEDICAL LICENSE