Healthcare Provider Details

I. General information

NPI: 1083765762
Provider Name (Legal Business Name): THOMAS JEFFREY TRAYNHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E REYNOLDS ST
PLANT CITY FL
33563-3756
US

IV. Provider business mailing address

5000 CHESHIRE LN N
PLYMOUTH MN
55446-3706
US

V. Phone/Fax

Practice location:
  • Phone: 813-754-3955
  • Fax: 813-754-7498
Mailing address:
  • Phone: 763-268-4169
  • Fax: 763-268-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS 2399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: