Individual
TRACY LEE BIGELOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2545 W HAMMER LN, STOCKTON, CA 95209-2839
(209) 957-7050
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
20A11567
CA
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
20A 11567
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A 11567
CALIFORNIA OSTEOPATHIC MEDICAL LICENSE
CA
05
—
2671158
—
OH
01
—
34008758
OHIO MEDICAL LICENSE
OH
Enumeration date
09/21/2006
Last updated
09/15/2015
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