Healthcare Provider Details

I. General information

NPI: 1912178526
Provider Name (Legal Business Name): TRACEY MARIE COLUMB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACEY MARIE GUILDENBECHER MD

II. Dates (important events)

Enumeration Date: 03/23/2008
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 KATLIAN ST
SITKA AK
99835-7359
US

IV. Provider business mailing address

827 NE 63RD AVE
PORTLAND OR
97213-4337
US

V. Phone/Fax

Practice location:
  • Phone: 907-747-5861
  • Fax: 907-747-5415
Mailing address:
  • Phone: 503-927-5574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6821
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: