Tracy, Wallace Lee
Tracy, Wallace Lee is an sole proprietor health care provider with primary practice located at 1940 S Whitehead Dr , De Witt AR 72042-2906. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Tracy, Wallace Lee can be contacted via phone (870) 946-4505.Contact Information
Primary practice address
1940 S Whitehead Dr
De Witt AR 72042-2906
Phone: (870) 946-4505
Fax: (870) 946-2428
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | C7340 | Arkansas |
Profile Details
| NPI number | 1366438384 |
|---|---|
| LBN Legal business name | Tracy, Wallace Lee |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 26th, 2005 |
| Last updated | Sep 16th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366438384 | NPPES |
| Arkansas | MEDICAID | 114942001 |
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