Provider Demographics
NPI:1962603530
Name:TAGGART, TRACY ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ANNE
Last Name:TAGGART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:TAGGART
Other - Last Name:WIESBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1462
Mailing Address - Fax:360-729-3104
Practice Address - Street 1:PEACEHEALTH UNITED GENERAL MEDICAL CENTER
Practice Address - Street 2:2000 HOSPITAL DRIVE
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284
Practice Address - Country:US
Practice Address - Phone:360-856-7588
Practice Address - Fax:360-856-7252
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-48236208600000X, 2086S0127X
WAMD60957762208600000X
OR27912208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery