Individual
TRACI GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
THAD9292
Contact information
Practice address
9301 E SHEA BLVD STE 113, SCOTTSDALE, AZ 85260-6735
(480) 661-1311
Mailing address
9301 E SHEA BLVD STE 113, SCOTTSDALE, AZ 85260-6735
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
THAD9292
AZ
Other
Enumeration date
03/04/2015
Last updated
03/04/2015
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