Provider Demographics
NPI:1023271681
Name:CARBAJAL, TRACEY OWENSBY (MD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:OWENSBY
Last Name:CARBAJAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1625 NICHOLASVILLE RD
Mailing Address - Street 2:APT. 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1436
Mailing Address - Country:US
Mailing Address - Phone:985-533-4210
Mailing Address - Fax:985-533-4210
Practice Address - Street 1:1700 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 701
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1431
Practice Address - Country:US
Practice Address - Phone:859-278-0396
Practice Address - Fax:859-278-0396
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2017-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY49705207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology