Provider Demographics
NPI:1538259791
Name:THOMAS, TRACI LEE (DO)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:LEE
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7410 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73169-1412
Mailing Address - Country:US
Mailing Address - Phone:405-682-4075
Mailing Address - Fax:405-680-4476
Practice Address - Street 1:7410 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73169-1412
Practice Address - Country:US
Practice Address - Phone:405-682-4075
Practice Address - Fax:405-680-4476
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8EF185OtherMEDICARE
OK8EF185OtherMEDICARE