Provider Demographics
NPI:1487262028
Name:TRAC, DAVID Q (MD, PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:Q
Last Name:TRAC
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5672 PENDLETON DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-7330
Mailing Address - Country:US
Mailing Address - Phone:407-790-5411
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E RM 1C026
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0002
Practice Address - Country:US
Practice Address - Phone:801-581-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-50072207P00000X
MI4301511326207P00000X
AZ73231207P00000X
UT12952643-1205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine