Doctor Name: | TRACY CLEARY |
NPI Number: | 1003257122 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | CNIM2102 |
Business Practice Address: | 1207 Running Bear Trl Crosby, TX - 775323618 |
Business Phone Number: | 2814627684 |
Business Fax Number: | |
Mailing Address: | Po Box 1651, CROSBY |
State: | TX |
Postal Code: | 775321651 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/17/2013 |
NPI Last Update Date: | 07/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246ZE0600X |
License Number: | CNIM2102 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Specialist/Technologist, Other |
Taxonomy Specialization: | Electroneurodiagnostic |
Taxonomy Definition: |