Provider Demographics
NPI:1871593178
Name:REED, TRACY MARIA (DPM)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MARIA
Last Name:REED
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 959354
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-9354
Mailing Address - Country:US
Mailing Address - Phone:314-953-8223
Mailing Address - Fax:314-273-1654
Practice Address - Street 1:11125 DUNN ROAD SUITE 301
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63195-4952
Practice Address - Country:US
Practice Address - Phone:314-953-8223
Practice Address - Fax:314-273-1654
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000797213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2700520OtherUNITED HEALTHCARE
133181OtherBLUE CROSS BLUE SHIELD
MO304715402Medicaid
431866203OtherCOMMUNITY CARE PLUS
480035186OtherRAILROAD MEDICARE
7805244OtherAETNA
463755OtherHEALTHLINK INC
550812530OtherMERCY HEALTH PLAN
MO000021546Medicare ID - Type Unspecified
MO304715402Medicaid