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1982866935 NPI number — TRACY T MACK MD

NPI Number: 1982866935
Health Care Provider/Practitioner: TRACY T MACK MD

Information about “1982866935” NPI (TRACY T MACK MD) exists in 1982866935 in HTML format HTML  |  1982866935 in plain Text format TXT  |  1982866935 in PDF (Portable Document Format) PDF  |  1982866935 in an XML format XML  formats.

NPI Number : 1982866935 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1982866935",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MACK",
    "FirstName": "TRACY",
    "MiddleName": "T",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "300 EAST 6TH STREET",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TEXARKANA",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "71854",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "870-779-6004",
    "MailingAddressFaxNumber": "870-779-6119",
    "FirstLinePracticeLocationAddress": "300 EAST 6TH STREET",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TEXARKANA",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "71854",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "870-779-6004",
    "PracticeLocationAddressFaxNumber": "870-779-6119",
    "EnumerationDate": "07/01/2008",
    "LastUpdateDate": "06/24/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "67268",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "64851",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "E-6786",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "R4528",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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