Healthcare Provider Details

I. General information

NPI: 1255835070
Provider Name (Legal Business Name): TRACY WADSWORTH MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY WADSWORTH ROHRBACH MD, MS

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

5009 NEZ PERCE WAY
BAKERSFIELD CA
93312-5372
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 951-312-2702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: