Provider Demographics
NPI:1780117754
Name:WANG, TRACY (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WANG
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 1:801 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-3573
Mailing Address - Country:US
Mailing Address - Phone:940-612-8750
Mailing Address - Fax:940-668-2663
Practice Address - Street 1:801 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-3573
Practice Address - Country:US
Practice Address - Phone:940-612-8750
Practice Address - Fax:940-668-2663
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS6325208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics