Provider Demographics
NPI:1982049995
Name:GEORGE G TRACY MD LLC
Entity Type:Organization
Organization Name:GEORGE G TRACY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:G
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-747-6950
Mailing Address - Street 1:2401 STANFORD RD APT 224
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3573
Mailing Address - Country:US
Mailing Address - Phone:850-747-6950
Mailing Address - Fax:850-747-6208
Practice Address - Street 1:2401 STANFORD RD APT 224
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3573
Practice Address - Country:US
Practice Address - Phone:850-747-6950
Practice Address - Fax:850-747-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45073207P00000X, 207PE0005X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD62480Medicare UPIN