Individual
TRACY TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11 CREST RD, SAINT ALBANS, VT 05478-9701
(802) 527-8189
(802) 527-8187
Mailing address
600 BLAIR PARK RD STE 285, WILLISTON, VT 05495-7586
(802) 288-1140
(802) 288-1144
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
ME96031
FL
208000000X
Pediatrics Physician
Primary
ME96031
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202194472A
—
GA
05
—
275570000
—
FL
01
—
57012
BCBS
FL
Enumeration date
07/02/2006
Last updated
06/30/2023
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