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General NPI Number Information
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NPI Number | 1588664064
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Entity Type | Individual
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Provider Name | RAYMOND D TRACY D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2005
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 6087 E FILMORE RD
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City | WALKERVILLE
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State | MI
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Zip | 49459-9344
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Country | US
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Telephone | 231-854-7655
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Fax | 231-854-7704
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Provider Business Mailing Address
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Address Line | 3944 BRENLOR DRIVE
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City | HESPERIA
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State | MI
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Zip | 49421
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Country | US
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Telephone | 231-854-2999
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Fax | 231-854-2998
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | RT007455
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License Number State | MI
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