Provider Demographics
NPI:1801888300
Name:TRACY, JAMES M (DO)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:TRACY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2808 S 80 AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3253
Mailing Address - Country:US
Mailing Address - Phone:402-391-1800
Mailing Address - Fax:402-391-1563
Practice Address - Street 1:2808 S 80 AVE
Practice Address - Street 2:STE 210
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3253
Practice Address - Country:US
Practice Address - Phone:402-391-1800
Practice Address - Fax:402-391-1563
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE154207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47060801501Medicaid
NE47060801514Medicaid
NE47060801514Medicaid
NE265648Medicare PIN