Individual
THOMAS NICHOLAS TRACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4316 JAMES CASEY ST, BUILDING C, AUSTIN, TX 78745-1157
(512) 623-5300
(512) 623-5399
Mailing address
PO BOX 1509, SAN ANTONIO, TX 78295-1509
(512) 623-5300
(512) 623-5399
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
G3861
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060020153
MEDICARE RAILROAD
TX
05
—
131767902
—
TX
05
—
131767907
—
TX
05
—
131767908
—
TX
01
—
8BX079
BCBSTX
TX
01
—
P00706407
MEDICARE RAILROAD
—
Enumeration date
12/14/2005
Last updated
06/24/2011
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