Healthcare Provider Details

I. General information

NPI: 1538622170
Provider Name (Legal Business Name): TRACY RENE STAMMANN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22001 SOUTHWEST FWY STE 300
RICHMOND TX
77469-7002
US

IV. Provider business mailing address

4911 SANDHILL DR
SUGAR LAND TX
77479-5320
US

V. Phone/Fax

Practice location:
  • Phone: 281-239-5037
  • Fax: 281-762-5399
Mailing address:
  • Phone: 281-238-7870
  • Fax: 281-633-4985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT4061
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: