Provider Demographics
NPI:1316129356
Name:HAINES, TRACY A (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:A
Last Name:HAINES
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 1:4350 LIMELIGHT AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8034
Mailing Address - Country:US
Mailing Address - Phone:720-686-7546
Mailing Address - Fax:
Practice Address - Street 1:4350 LIMELIGHT AVE STE 205
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8034
Practice Address - Country:US
Practice Address - Phone:720-686-7546
Practice Address - Fax:720-686-7544
Is Sole Proprietor?:No
Enumeration Date:2007-12-01
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37147207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
013676OtherKAISER COMMERCIAL NUMBER
CO01371475Medicaid
013676OtherKAISER COMMERCIAL NUMBER
COC465728Medicare PIN