Individual
ELIZABETH TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1027 BELLEVUE AVE, SUITE 107, SAINT LOUIS, MO 63117-1851
(314) 645-3743
(314) 647-7967
Mailing address
PO BOX 23340, SAINT LOUIS, MO 63156-3340
(314) 645-3743
(314) 647-7967
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R6J71
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000010039
ESSENCE
MO
01
—
0400404
UHC
MO
01
—
101209
HEALTHLINK
MO
01
—
127483
GHP
MO
01
—
16533
BCBS
MO
01
—
4090137
AETNA
MO
01
—
E62302
MERCY
MO
Enumeration date
11/16/2005
Last updated
10/01/2012
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