Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 26618 | KY |
NPI | 1003848763 |
---|---|
Provider Name | Robert N Tracy |
First Address | Cincinnati, OH 45263-5283 |
Second Address | Highland Heights, KY 41076-1530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 07/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101286 | (05) | OH |
080092534 | RAILROAD MEDICARE (01) | KY |
64266182 | (05) | KY |
F07138 | (02) | KY |
P00839856 | RAILROAD MEDICARE (01) | KY |