Individual
NATHAN DANIEL TRACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8800 MONTGOMERY BLVD NE, FAMILY MEDICINE, ALBUQUERQUE, NM 87111-2310
(505) 462-6400
(505) 462-6506
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 462-6400
(505) 462-6506
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
9992A
WY
207Q00000X
Family Medicine Physician
Primary
DO2024-0079
NM
Other
Enumeration date
04/13/2011
Last updated
06/13/2024
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