MEDICARE: TRACY L THOMPSON

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	207Q00000X	Family Medicine Physician	OK3319	OK

General Provider Information

NPI Number	:	1639162704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY L THOMPSON

Provider Business Mailing Address
First Line	:	1925 WARRIOR WAY
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-3491
Country	:	US
Telephone Number	:	580-421-4570
Fax Number	:	580-421-6283

Provider Business Practice Location Address
First Line	:	1921 STONECIPHER DR
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-3439
Country	:	US
Telephone Number	:	580-436-3980
Fax Number	:	580-421-6283

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/10/2024

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Directions to “ TRACY L THOMPSON ” Practice Location

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