Provider Demographics
NPI:1689142127
Name:TRACY BYERLY II MD PA
Entity type:Organization
Organization Name:TRACY BYERLY II MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-997-4000
Mailing Address - Street 1:205 W WINDCREST ST STE 210
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4480
Mailing Address - Country:US
Mailing Address - Phone:830-997-4000
Mailing Address - Fax:830-997-2028
Practice Address - Street 1:205 W WINDCREST ST STE 210
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4480
Practice Address - Country:US
Practice Address - Phone:830-997-4000
Practice Address - Fax:830-997-2028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRACY BYERLY II, MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-02
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1427354208OtherBCBS