Individual
TRACEY JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
44572 W. BOWLIN ROAD, MARICOPA, AZ 85138-8922
(480) 216-9417
Mailing address
44572 W. BOWLIN ROAD, MARICOPA, AZ 85138-8922
(480) 216-9417
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6316
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114369
—
AZ
Enumeration date
02/15/2016
Last updated
07/21/2022
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