Provider Demographics
NPI:1952350910
Name:READ, TRACY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:READ
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 1:1475 MOUNT HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-9066
Mailing Address - Country:US
Mailing Address - Phone:503-982-2174
Mailing Address - Fax:503-982-4599
Practice Address - Street 1:1475 MOUNT HOOD AVE
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9066
Practice Address - Country:US
Practice Address - Phone:503-982-2174
Practice Address - Fax:503-982-4599
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19842207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR081096Medicaid
ORG32100Medicare UPIN
OR081096Medicaid