Provider Demographics
NPI:1902805534
Name:SCHMUCKER, TRACEY A (MD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:A
Last Name:SCHMUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7329
Mailing Address - Country:US
Mailing Address - Phone:501-268-7154
Mailing Address - Fax:501-268-9071
Practice Address - Street 1:105 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7329
Practice Address - Country:US
Practice Address - Phone:501-268-7154
Practice Address - Fax:501-268-9071
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3864207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04010020700OtherQUALCHOICE
AR2335915OtherUNITED HEALTHCARE
AR7616013OtherCIGNA
AR54723OtherCOORDINATED VISION CARE
AR7144524OtherAETNA
AR5B955OtherBLUE CROSS PAY TO
AR621710274OtherTAX ID
ARP00081947OtherRAILROAD MEDICARE
AR5M726OtherBLUE CROSS INDIVIDUAL
ARCJ3133OtherRAILROAD MCARE GROUP
AR152290001Medicaid
AR2335915OtherUNITED HEALTHCARE
ARP00081947OtherRAILROAD MEDICARE
AR5M726Medicare ID - Type UnspecifiedMCARE INDIVIDUAL