MEDICARE: TRACI MCCORMICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	25413	AL

General Provider Information

NPI Number	:	1255381562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI MCCORMICK MD

Provider Business Mailing Address
First Line	:	1 HOSPITAL DR SW STE 100
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3495
Country	:	US
Telephone Number	:	256-319-5400
Fax Number	:	256-327-5977

Provider Business Practice Location Address
First Line	:	1312 7TH ST SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-3340
Country	:	US
Telephone Number	:	256-319-5400
Fax Number	:	256-327-5977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	04/04/2023

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