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General NPI Number Information
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NPI Number | 1962603530
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Entity Type | Individual
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Provider Name | TRACY ANNE TAGGART M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 18523 CORWIN RD STE A
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City | APPLE VALLEY
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State | CA
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Zip | 92307-2300
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Country | US
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Telephone | 909-712-2764
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 SE 164TH AVE DEPT 358
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City | VANCOUVER
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State | WA
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Zip | 98683-8004
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Country | US
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Telephone | 360-729-1462
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Fax | 360-729-3104
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD-48236
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD60957762
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C175274
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | MD-48236
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License Number State | IA
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 27912
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License Number State | OR
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