Provider Demographics
NPI:1588720452
Name:MRACEK, JAMES F (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:MRACEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:807 JACKSON TRACE RD
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-1504
Mailing Address - Country:US
Mailing Address - Phone:334-567-3150
Mailing Address - Fax:334-567-3152
Practice Address - Street 1:807 JACKSON TRACE RD
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-1504
Practice Address - Country:US
Practice Address - Phone:334-567-3150
Practice Address - Fax:334-567-3152
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00018329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000033706Medicaid
ALF83815Medicare UPIN