Provider Demographics
NPI:1932229614
Name:CHAVEZ, TRACY CAMILLE (PA-C)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:CAMILLE
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-320-2929
Mailing Address - Fax:303-320-2767
Practice Address - Street 1:4545 E. 9TH AVE
Practice Address - Street 2:SUITE 630
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-320-2929
Practice Address - Fax:303-320-2767
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1073937363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31777058Medicaid
CO60827211Medicaid
CO31777058Medicaid
COCO303520Medicare PIN