Individual
DR. TRACY JON TIPTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
125 DOUGHTY ST STE 300, CHARLESTON, SC 29403
(843) 884-8045
(843) 881-5081
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
36003
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
360031
—
SC
01
—
9223
GROUP MEDICARE PTAN
SC
Enumeration date
06/21/2013
Last updated
06/28/2021
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