MEDICARE: TRACI LEE THOMAS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4376	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8EF185	OTHER	OK	MEDICARE

General Provider Information

NPI Number	:	1538259791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI LEE THOMAS D.O.

Provider Business Mailing Address
First Line	:	7410 MACARTHUR BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73169-1412
Country	:	US
Telephone Number	:	405-682-4075
Fax Number	:	405-680-4476

Provider Business Practice Location Address
First Line	:	7410 MACARTHUR BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73169-1412
Country	:	US
Telephone Number	:	405-682-4075
Fax Number	:	405-680-4476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	01/26/2024

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