Healthcare Provider Details

I. General information

NPI: 1508312349
Provider Name (Legal Business Name): JAMES R TRAHAN MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 UNIVERSITY BLVD SUITE #122
AMES IA
50010-8629
US

IV. Provider business mailing address

2521 UNIVERSITY BLVD SUITE #122
AMES IA
50010-8629
US

V. Phone/Fax

Practice location:
  • Phone: 515-292-2150
  • Fax: 515-292-2184
Mailing address:
  • Phone: 515-292-2150
  • Fax: 515-292-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number27031
License Number StateIA

VIII. Authorized Official

Name: JAMES RAY TRAHAN
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 515-292-2150