Provider Demographics
NPI:1427046929
Name:THOMAS-DOYLE, TRACEY ANN (MD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANN
Last Name:THOMAS-DOYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:ANN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3417 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4008
Mailing Address - Country:US
Mailing Address - Phone:850-432-7310
Mailing Address - Fax:
Practice Address - Street 1:3417 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4008
Practice Address - Country:US
Practice Address - Phone:850-432-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94326207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274260800Medicaid
FL274260800Medicaid
H44258Medicare UPIN