Most Relevant Information
Provider Data
| NPI Number: | 1003320334 |
| Provider Name: | TRACY IRANSHAHR TRACY |
| Entity Type: | Individual |
| Taxonomy Code: | 2355S0801X |
| Specialty: | Specialist/Technologist |
| License Number: | SLPA10666 |
Most Important Dates
| Enumeration Date: | 11/22/2017 |
| Last Updated: | 11/22/2017 |
Provider Practice Location
2745 N BLACK ROCK RD
BUCKEYE
AZ
853961813
Practice Location Phone/Fax
| Phone: | 6235377224 |
| Fax: |
Provider Mailing Location
2745 N BLACK ROCK RD
BUCKEYE
AZ
853961813
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |