MEDICARE: DEVIN TRACY PA-C

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	363A00000X	Physician Assistant	5959165-1206	UT

General Provider Information

NPI Number	:	1467750604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVIN TRACY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 30180
Second Line	:	SUITE 600
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84130-0180
Country	:	US
Telephone Number	:	801-920-5813
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 E 2ND ST STE 3
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2641
Country	:	US
Telephone Number	:	307-237-2300
Fax Number	:

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

Provider Enumeration Date	:	03/12/2011
Last Update Date	:	03/25/2016

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Directions to “ DEVIN TRACY PA-C” Practice Location

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