Individual
TRACY FUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3303 SW BOND AVE # 16D, OHSU DEPARTMENT OF DERMATOLOGY, PORTLAND, OR 97239-4501
(503) 418-3376
(503) 346-8106
Mailing address
3303 SW BOND AVE # 16D, OHSU DEPARTMENT OF DERMATOLOGY, PORTLAND, OR 97239-4501
(503) 418-3376
(503) 346-8106
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
173370
OR
208000000X
Pediatrics Physician
47554
CO
390200000X
Student in an Organized Health Care Education/Training Program
47554
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82253862
—
CO
Enumeration date
04/14/2007
Last updated
06/17/2015
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