Provider Demographics
NPI:1255334736
Name:BULLARD, TRACY ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ELIZABETH
Last Name:BULLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:150 IVEY LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9817
Mailing Address - Country:US
Mailing Address - Phone:910-215-5210
Mailing Address - Fax:910-215-5215
Practice Address - Street 1:150 IVEY LANE
Practice Address - Street 2:SUITE B
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9817
Practice Address - Country:US
Practice Address - Phone:910-215-5210
Practice Address - Fax:910-215-5215
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-01439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891368CMedicaid
NC891368CMedicaid