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General NPI Number Information
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NPI Number | 1043202203
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Entity Type | Individual
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Provider Name | MARK E TRACY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 08/22/2012
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Provider Practice Location Address
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Address Line | 601 E ROLLINS ST
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City | ORLANDO
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State | FL
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Zip | 32803-1248
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Country | US
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Telephone | 407-303-2578
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Fax |
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Provider Business Mailing Address
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Address Line | 2718 N ORANGE AVE SUITE C
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City | ORLANDO
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State | FL
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Zip | 32804-7611
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Country | US
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Telephone | 407-303-2578
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036-109303
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME113742
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License Number State | FL
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