Individual
TRACY A DEWENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2021 PERDIDO ST, NEW ORLEANS, LA 70112-1352
(504) 568-2315
Mailing address
1340 POYDRAS ST, SUITE 1640, NEW ORLEANS, LA 70112-1221
(504) 412-1835
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
026496
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1062545
—
LA
Enumeration date
09/21/2007
Last updated
11/17/2008
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