MEDICARE: DR. TRACY LYNN DAVIS MD PHD

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	207ZP0101X	Anatomic Pathology Physician	41612	AZ
2	207ZD0900X	Dermatopathology (Pathology) Physician	41612	AZ
3	207ZP0101X	Anatomic Pathology Physician	A99627	CA
4	207ZD0900X	Dermatopathology (Pathology) Physician	A99627	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447287362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY LYNN DAVIS MD PHD

Provider Business Mailing Address
First Line	:	2495 N DESERT LINKS DR APT 85
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3736
Country	:	US
Telephone Number	:	602-320-6105
Fax Number	:

Provider Business Practice Location Address
First Line	:	2495 N DESERT LINKS DR APT 85
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3736
Country	:	US
Telephone Number	:	602-320-6105
Fax Number	:

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	08/10/2015

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