MEDICARE: TRACEY JOHN P.A.-C

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	363A00000X	Physician Assistant	6316	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780043174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY JOHN P.A.-C

Provider Business Mailing Address
First Line	:	44572 W. BOWLIN ROAD
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-8922
Country	:	US
Telephone Number	:	480-216-9417
Fax Number	:

Provider Business Practice Location Address
First Line	:	44572 W. BOWLIN ROAD
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-8922
Country	:	US
Telephone Number	:	480-216-9417
Fax Number	:

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

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	07/21/2022

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Directions to “ TRACEY JOHN P.A.-C” Practice Location

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