Individual
TRACY C ORTON
Active
Individual
TRACY C ORTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
116144
MO
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
116144
MO
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
5101017139
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437122744
—
MI
01
—
701000217
MO MEDICARE
MO
01
—
D16150188
MEDICARE PROVIDER NUMBER
MI
Enumeration date
02/08/2006
Last updated
10/20/2020
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