Provider Demographics
NPI:1194722561
Name:HOFEDITZ, TRACY S (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:S
Last Name:HOFEDITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S TELLER STREET
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226
Mailing Address - Country:US
Mailing Address - Phone:303-232-8383
Mailing Address - Fax:303-232-8207
Practice Address - Street 1:325 S TELLER STREET
Practice Address - Street 2:SUITE 250
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226
Practice Address - Country:US
Practice Address - Phone:303-232-8383
Practice Address - Fax:303-232-8207
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO29068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01290683Medicaid
CON1304Medicare ID - Type Unspecified
808885Medicare PIN
COE54798Medicare UPIN