=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922090281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS TRACY GIDUZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2005
-----------------------------------------------------
Last Update Date | 03/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 ELLSWORTH PL
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27516-4624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-971-7245
-----------------------------------------------------
Fax | 919-967-1036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 ELLSWORTH PL
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27516-4624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-971-7245
-----------------------------------------------------
Fax | 919-967-1036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 31723
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------