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TRACY FUNK MD

Physicians Dermatology

Provider NPI: 1053536268

Provider Information:
 TRACY  FUNK MD
Gender: F
Not Sole Proprietor

Practice Location:
3303 SW BOND AVE # 16D OHSU DEPARTMENT OF DERMATOLOGY PORTLAND, OR 97239-4501 US
Tel: 503-418-3376  Fax: 503-346-8106

Business Mailing Address:
3303 SW BOND AVE # 16D OHSU DEPARTMENT OF DERMATOLOGY PORTLAND, OR 97239-4501 US
Tel: 503-418-3376  Fax: 503-346-8106

NPI Information:
NPI: 1053536268
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207N00000XPhysicians
Dermatology
OR173370
N208000000XPhysicians
Pediatrics
CO47554
N390200000XStudent
Organized Health Care Education/Training Program
CO47554

Other Provider Identifiers:

IssuerNumberStateType
82253862CO05



American Medical Association 2012 taxonomy code information

Code: 207N00000X

Type:

Classification:



Definition:



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