Provider Demographics
NPI:1699792291
Name:MUNFORD, TRACY RUKAB (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:RUKAB
Last Name:MUNFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:MARIE
Other - Last Name:RUKAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-433-5441
Practice Address - Street 1:6100 HARRIS PARKWAY
Practice Address - Street 2:SUITE 320
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4133
Practice Address - Country:US
Practice Address - Phone:817-433-5499
Practice Address - Fax:817-433-5441
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2615207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00097453OtherRAILROAD MEDICARE
TX161010701Medicaid
H58166Medicare UPIN