Provider Demographics
NPI:1174580286
Name:OSBORNE, TRACY J (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:J
Last Name:OSBORNE
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 1:397 WALLACE RD STE C100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-8018
Mailing Address - Country:US
Mailing Address - Phone:615-834-6166
Mailing Address - Fax:615-781-9755
Practice Address - Street 1:397 WALLACE RD STE C100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-8018
Practice Address - Country:US
Practice Address - Phone:615-834-6166
Practice Address - Fax:615-781-9755
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29079207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F71831Medicare UPIN
3812410Medicare ID - Type Unspecified