Healthcare Provider Details

I. General information

NPI: 1801888300
Provider Name (Legal Business Name): JAMES M TRACY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 S 80 AVE STE 210
OMAHA NE
68124-3253
US

IV. Provider business mailing address

2808 S 80 AVE STE 210
OMAHA NE
68124-3253
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-1800
  • Fax: 402-391-1563
Mailing address:
  • Phone: 402-391-1800
  • Fax: 402-391-1563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number154
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: