Basic Information
| Provider Information | |||||||||
| NPI: | 1427025253 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOTEN | ||||||||
| FirstName: | TRACEY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13722 EMBASSY ROW | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103495592 | ||||||||
| FaxNumber: | 2103495628 | ||||||||
| Practice Location | |||||||||
| Address1: | 13722 EMBASSY ROW | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103495592 | ||||||||
| FaxNumber: | 2103495628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 11/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H5496 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.