=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245547645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT TRACY FILES PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2010
-----------------------------------------------------
Last Update Date | 06/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 HOSPITAL DR
-----------------------------------------------------
City | EUFAULA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74432-4010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-689-3333
-----------------------------------------------------
Fax | 918-689-3345
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 HOSPITAL DR
-----------------------------------------------------
City | EUFAULA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74432-4010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-689-3333
-----------------------------------------------------
Fax | 918-689-3345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | P-T1013
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 2268
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------