MEDICARE: TRACY ELIZABETH FOOSE M.D.

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	2084P0800X	Psychiatry Physician	240963	NY
2	2084P0800X	Psychiatry Physician	103132	CA

General Provider Information

NPI Number	:	1750509006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY ELIZABETH FOOSE M.D.

Provider Business Mailing Address
First Line	:	655 REDWOOD HWY FRONTAGE RD STE 340
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-3057
Country	:	US
Telephone Number	:	415-888-3467
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 REDWOOD HWY FRONTAGE RD STE 340
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-3057
Country	:	US
Telephone Number	:	415-888-3467
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/15/2024

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