Individual
TRACEY KATHLEEN TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
506 4TH ST, LA GRANDE, OR 97850
(541) 663-3138
(541) 975-5120
Mailing address
506 4TH ST, LA GRANDE, OR 97850-1906
(541) 663-3138
(541) 975-5120
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD151037
OR
207Q00000X
Family Medicine Physician
MD60747878
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500620109
—
OR
01
—
P00965892
RR MEDICARE
OR
Enumeration date
08/22/2008
Last updated
04/05/2022
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