Healthcare Provider Details

I. General information

NPI: 1639554272
Provider Name (Legal Business Name): TRACY S. HUNTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S CHIPETA WAY RM 201
SALT LAKE CITY UT
84108-1260
US

IV. Provider business mailing address

375 S CHIPETA WAY RM 201
SALT LAKE CITY UT
84108-1260
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 801-581-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14164619-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number29912
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: