Healthcare Provider Details

I. General information

NPI: 1063563823
Provider Name (Legal Business Name): MATTHEW P TRAYNOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PROVIDENCE WAY
IDAHO FALLS ID
83404
US

IV. Provider business mailing address

2100 PROVIDENCE WAY
IDAHO FALLS ID
83404-4951
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-6600
  • Fax: 208-529-6602
Mailing address:
  • Phone: 208-529-6600
  • Fax: 208-529-6602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberM-10686
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberM-10686
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: