Healthcare Provider Details

I. General information

NPI: 1578536736
Provider Name (Legal Business Name): JOHN PAUL TRAFELI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2989 EAST AROW STREET
YUMA AZ
85365
US

IV. Provider business mailing address

PSC 851 BOX 340
FPO AE
09834-0004
US

V. Phone/Fax

Practice location:
  • Phone: 928-269-5749
  • Fax:
Mailing address:
  • Phone: 318-439-8162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01053757A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA97517
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberA97517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: