MEDICARE: TRACY TOMMACK DVM

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	174M00000X	Veterinarian	8621	TX

General Provider Information

NPI Number	:	1407237225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY TOMMACK DVM

Provider Business Mailing Address
First Line	:	2250 THOUSAND OAKS DR STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3968
Country	:	US
Telephone Number	:	210-495-8245
Fax Number	:	210-495-1972

Provider Business Practice Location Address
First Line	:	2250 THOUSAND OAKS DR STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3968
Country	:	US
Telephone Number	:	210-495-8245
Fax Number	:	210-495-1972

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

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	06/17/2015

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