Provider Demographics
NPI:1215165394
Name:HARBERT, TRACEY L (MD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:HARBERT
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 1:1124 COLUMBIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2026
Mailing Address - Country:US
Mailing Address - Phone:206-576-6050
Mailing Address - Fax:206-215-5935
Practice Address - Street 1:1124 COLUMBIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2026
Practice Address - Country:US
Practice Address - Phone:206-576-6050
Practice Address - Fax:206-215-5935
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60550691207ZP0102X
MN106842207ZP0102X
MN56903207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MNENROLLEDMedicaid