Provider Demographics
NPI:1194744466
Name:RADFORD, TRACI K (MD)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:K
Last Name:RADFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 N CENTRAL EXPY
Mailing Address - Street 2:STE 450
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3140
Mailing Address - Country:US
Mailing Address - Phone:214-821-8055
Mailing Address - Fax:214-821-3661
Practice Address - Street 1:4144 N CENTRAL EXPY
Practice Address - Street 2:STE 450
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3140
Practice Address - Country:US
Practice Address - Phone:214-821-8055
Practice Address - Fax:214-821-3661
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4459207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF96593Medicare UPIN
TX89672FMedicare ID - Type Unspecified
TX89672FMedicare PIN