Provider Demographics
NPI:1932580263
Name:TRACY, DYLAN (DO)
Entity Type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:
Last Name:TRACY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:MR
Other - First Name:DYLAN
Other - Middle Name:
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:16110 8TH AVE SW STE A2
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2962
Mailing Address - Country:US
Mailing Address - Phone:206-242-8280
Mailing Address - Fax:206-242-8302
Practice Address - Street 1:16110 8TH AVE SW STE A2
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2962
Practice Address - Country:US
Practice Address - Phone:206-242-8280
Practice Address - Fax:206-242-8302
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1646207Q00000X
IL125067436207Q00000X
WAOP61102294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2180613Medicaid