Individual
DR. TRACY MALONEY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Mailing address
PO BOX 6048, BEND, OR 97708-6048
(541) 382-4900
(541) 706-2398
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DO173559
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500689879
—
OR
01
—
DO173559
OR LICENSED
OR
Enumeration date
04/11/2012
Last updated
01/29/2022
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