Provider Demographics
NPI:1538257357
Name:TRACY, DEBORAH H (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:H
Last Name:TRACY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5719
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-5719
Mailing Address - Country:US
Mailing Address - Phone:352-597-0907
Mailing Address - Fax:352-597-2243
Practice Address - Street 1:11319 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5407
Practice Address - Country:US
Practice Address - Phone:352-597-0907
Practice Address - Fax:352-597-2243
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54724208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
050035162OtherRRMC
FL062538800Medicaid
07882OtherBLUE CROSS
E21436Medicare UPIN
FL062538800Medicaid