Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | J8193 | TX |
NPI | 1013963198 |
---|---|
Provider Name | Tracey Rae Adams |
First Address | Southlake, TX 76092-3939 |
Second Address | Dallas, TX 75224-1650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G10864 | (02) | TX |