Provider Demographics
NPI:1487971297
Name:BANKS-GRECZANIK, TRACEY ANELLE (DO)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANELLE
Last Name:BANKS-GRECZANIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-4262
Practice Address - Fax:903-531-5970
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
TXQ7637207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-0818167-044OtherTRICARE
TX75-0818167-048OtherTRICARE
TX75-0818167-015OtherTRICARE
TX75-0818167-022OtherTRICARE
TX75-2616977-001OtherTRICARE
TX75-2616977-002OtherTRICARE
TX8GE201OtherBCBS
TX8GC841OtherBCBS
TXP01731690OtherRAIL ROAD MEDICARE
TX362978401Medicaid
TX362978403Medicaid
TX8GC843OtherBCBS
TXP01721579OtherRAIL ROAD MEDICARE
TXP01721588OtherRAIL ROAD MEDICARE
TX362978402Medicaid
TX8GC844OtherBCBS
TX362978404Medicaid
TX75-2616977-028OtherTRICARE
TX75-1976930-005OtherTRICARE
TX8GC844OtherBCBS
TX75-0818167-048OtherTRICARE
TX362978404Medicaid
TX529776YS6PMedicare PIN