Healthcare Provider Details

I. General information

NPI: 1942281928
Provider Name (Legal Business Name): TRACY ELIZABETH PAPA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 MONTGOMERY ST
FORT WORTH TX
76107-2553
US

IV. Provider business mailing address

PO BOX 99335
FORT WORTH TX
76199-0335
US

V. Phone/Fax

Practice location:
  • Phone: 817-735-2198
  • Fax:
Mailing address:
  • Phone: 817-735-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberH4599
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: