Individual
DR. TRACY THOMPSON LATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.S.
Contact information
Practice address
116 S MAIN ST, SUITE 301, MOORESVILLE, NC 28115-2373
(704) 662-3200
(704) 662-3288
Mailing address
116 S MAIN ST, SUITE 301, MOORESVILLE, NC 28115-2373
(704) 662-3200
(704) 662-3288
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
34660
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41028
ABPN CERT. # EXP. 2014
—
01
—
51148
BCBS
NC
01
—
58366
MEDCOST
NC
05
—
7951148
—
NC
01
—
NC 34660
STATE LICENSE
NC
Enumeration date
07/26/2006
Last updated
03/07/2023
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