Organization
LAUREL FORK FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN WILLIAM TRACY MD (OWNER)
(276) 398-2532
Entity
Organization
Contact information
Practice address
1205 STONE MOUNTAIN ROAD, LAUREL FORK, VA 24352
(276) 398-2532
(276) 398-2534
Mailing address
PO BOX 85, LAUREL FORK, VA 24352-0085
(276) 398-2532
(276) 398-2534
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101236128
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190001221
—
VA
Enumeration date
05/11/2018
Last updated
05/11/2018
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