Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | R3954 | KY |
NPI | 1154715159 |
---|---|
Provider Name | Dr. Gregory Tracy |
First Address | Lexington, KY 40503-2714 |
Second Address | Lexington, KY 40503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 29/06/2018 |