Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | TRN6923 | FL |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME104897 | FL |
N | 207XS0117X | Orthopaedic Spine Surgeon | ME104897 | FL |
NPI | 1740341544 |
---|---|
Provider Name | Tracy J Roberts |
First Address | Pensacola, FL 32513-2699 |
Second Address | Pensacola, FL 32504-8785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 20/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001050400 | (05) | FL |