Healthcare Provider Details

I. General information

NPI: 1982850665
Provider Name (Legal Business Name): TRACEY C CAWTHORN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 CITADEL PLZ STE 108
SAN ANTONIO TX
78209-1016
US

IV. Provider business mailing address

1747 CITADEL PLZ STE 108
SAN ANTONIO TX
78209-1016
US

V. Phone/Fax

Practice location:
  • Phone: 210-385-0400
  • Fax:
Mailing address:
  • Phone: 210-385-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberP4552
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberP4552
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberP4552
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberP4552
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License NumberP4552
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberP4552
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberP4552
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: