Provider Demographics
NPI:1619592987
Name:PHAN, TRACY THUY (DO)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:THUY
Last Name:PHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:100 KETTERING WAY STE 100
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1155
Practice Address - Country:US
Practice Address - Phone:937-746-8357
Practice Address - Fax:937-522-7079
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA94295207Q00000X
OH34.017107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine