Healthcare Provider Details

I. General information

NPI: 1346356862
Provider Name (Legal Business Name): TRACY SMITH SANFORD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 BEACH BLVD STE 40
BILOXI MS
39531-4517
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 228-273-4611
  • Fax: 888-464-0522
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29341
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: