Individual
MR. SHANE TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2780 E BARNETT RD STE 200, MEDFORD, OR 97504
(541) 779-6250
(541) 608-2535
Mailing address
2780 E BARNETT RD STE 200, MEDFORD, OR 97504-8674
(541) 779-6250
(541) 608-2535
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA187850
OR
Other
Enumeration date
07/17/2017
Last updated
10/05/2022
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