Healthcare Provider Details

I. General information

NPI: 1699863019
Provider Name (Legal Business Name): JAMES RAY TRAHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 NE 54TH ST STE 201
KANSAS CITY MO
64118-4330
US

IV. Provider business mailing address

PO BOX 505260
SAINT LOUIS MO
63150-5260
US

V. Phone/Fax

Practice location:
  • Phone: 816-453-6777
  • Fax: 816-454-3601
Mailing address:
  • Phone: 816-436-7072
  • Fax: 816-436-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27031
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: