Provider Demographics
NPI:1174709612
Name:TRACEY, MATTHEW ALAN (DOM, AP)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALAN
Last Name:TRACEY
Suffix:
Gender:M
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 GRIFFIN RD STE E176
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-5500
Mailing Address - Country:US
Mailing Address - Phone:954-394-9098
Mailing Address - Fax:954-688-2526
Practice Address - Street 1:3325 GRIFFIN RD STE E176
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-5500
Practice Address - Country:US
Practice Address - Phone:954-797-8688
Practice Address - Fax:954-688-2526
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP953171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist