Individual
MR. TRACY GENE MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
820 E GRANT ST, APPLETON, WI 54911-3483
(920) 831-5050
(920) 738-6400
Mailing address
1904 N APPLETON ST, APPLETON, WI 54911-2737
(920) 882-6595
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
290-039
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290-039
STATE LICENSE NUMBER
WI
Enumeration date
02/27/2007
Last updated
07/08/2007
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