Provider Demographics
NPI:1588690481
Name:POOL, TRACY L (MD)
Entity type:Individual
Prefix:MR
First Name:TRACY
Middle Name:L
Last Name:POOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20250 CAPITOL HILL DR
Mailing Address - Street 2:
Mailing Address - City:TANNER
Mailing Address - State:AL
Mailing Address - Zip Code:35671-3638
Mailing Address - Country:US
Mailing Address - Phone:256-505-6826
Mailing Address - Fax:
Practice Address - Street 1:20250 CAPITOL HILL DR
Practice Address - Street 2:
Practice Address - City:TANNER
Practice Address - State:AL
Practice Address - Zip Code:35671-3638
Practice Address - Country:US
Practice Address - Phone:256-505-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18295207P00000X
ALMD 18295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-03705OtherBC
AL511-03705OtherBC
AL102I0088440Medicare PIN