Healthcare Provider Details

I. General information

NPI: 1053698027
Provider Name (Legal Business Name): DR TRACY HANKINS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 INJO DR
LAKE HAVASU CITY AZ
86403-5707
US

IV. Provider business mailing address

2010 INJO DR
LAKE HAVASU CITY AZ
86403-5707
US

V. Phone/Fax

Practice location:
  • Phone: 928-854-5400
  • Fax:
Mailing address:
  • Phone: 928-854-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number27481
License Number StateAZ

VIII. Authorized Official

Name: DR. TRACY HANKINS
Title or Position: OWNER
Credential: MD
Phone: 928-854-5400