Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 72 | AL |
Y | 222Z00000X | Podiatrist | 72 | AL |
NPI | 1073038667 |
---|---|
Provider Name | Mr. Tracy Delane Adams |
First Address | Huntsville, AL 35805-4166 |
Second Address | Huntsville, AL 35805-4166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2017 |
Last Update Date | 04/08/2017 |