Individual
TRACY LYNN ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3850 S NATIONAL AVE, SUITE 300, SPRINGFIELD, MO 65807-5287
(417) 269-6170
(417) 269-6992
Mailing address
PO BOX 3262, SPRINGFIELD, MO 65808-3262
(417) 885-3888
(417) 881-7268
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
R2P74
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1256
BLUE
MO
05
—
138386001
—
AR
05
—
209728914
—
MO
01
—
300100943
RRR MEDICARE
MO
01
—
P00807645
MEDICARE RAILROAD
MO
Enumeration date
03/23/2006
Last updated
03/23/2023
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