Provider Demographics
NPI:1053583872
Name:TRACY LAFLAIR MD PC
Entity type:Organization
Organization Name:TRACY LAFLAIR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LAFLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-393-0797
Mailing Address - Street 1:1107 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4496
Mailing Address - Country:US
Mailing Address - Phone:315-393-0797
Mailing Address - Fax:315-393-0529
Practice Address - Street 1:1107 LINDEN ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-4496
Practice Address - Country:US
Practice Address - Phone:315-393-0797
Practice Address - Fax:315-393-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208477174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
X88056Medicare UPIN
AA1563Medicare PIN