Provider Demographics
NPI:1831383439
Name:GLASS, TRACY LEE (DO)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LEE
Last Name:GLASS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BATES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-4828
Mailing Address - Country:US
Mailing Address - Phone:469-570-7001
Mailing Address - Fax:469-570-7002
Practice Address - Street 1:2001 BATES DR STE 200
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75167-4828
Practice Address - Country:US
Practice Address - Phone:469-570-7001
Practice Address - Fax:469-570-7002
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1649207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205523804Medicaid
TXTXB114088Medicare PIN