Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 14040 | KS |
NPI | 1003071978 |
---|---|
Provider Name | Terry Allen Tracy |
First Address | Topeka, KS 66612-1227 |
Second Address | Topeka, KS 66612-1227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2008 |
Last Update Date | 21/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02803610579 | AMA (01) |