1295831154 NPI number — TRACI L TORBERT DO

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295831154 NPI number — TRACI L TORBERT DO

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

TORBERT

Provider First Name:

TRACI

Provider Middle Name:

L

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

DO

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1295831154

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/25/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3700 EL CAMPO AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FORT WORTH

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

76107-4513

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

817-874-6605

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2801 FRANCISCAN DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BRYAN

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

77802-2544

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

979-776-3777

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/16/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207P00000X , with the licence number:  M4598 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 183394916 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 8X7670 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 183394915 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 183394903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 8V1549 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 183394904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 183394902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 183394909 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 8S6623 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 183394906 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 8BX429 . This is a "BCBS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 8X7457 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".