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General NPI Number Information
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NPI Number | 1770873531
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Entity Type | Individual
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Provider Name | NATHAN DANIEL TRACEY DO
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Gender | Male
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 8800 MONTGOMERY BLVD NE FAMILY MEDICINE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2310
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Country | US
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Telephone | 505-462-6400
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Fax | 505-462-6506
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PHS PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-462-6400
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Fax | 505-462-6506
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9992A
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO2024-0079
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License Number State | NM
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