Basic Information
| Provider Information | |||||||||
| NPI: | 1952385304 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2414 WALDEN WAY | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563019071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202537127 | ||||||||
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| Practice Location | |||||||||
| Address1: | 303 CATLIN ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553131947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7636847500 | ||||||||
| FaxNumber: | 7636847515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 32554 | MN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.