Individual
DR. JOHN WILLIAM TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1661 TURNER SPUR RD, FANCY GAP, VA 24328-4365
(276) 728-7212
(276) 728-5348
Mailing address
1661 TURNER SPUR RD, FANCY GAP, VA 24328-4365
(276) 728-7212
(276) 728-5348
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101236128
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101236128
LICENSE
VA
05
—
010137551
—
VA
Enumeration date
03/08/2006
Last updated
01/07/2008
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