Healthcare Provider Details

I. General information

NPI: 1760514038
Provider Name (Legal Business Name): ROBERT TERRY TRAWNIK B.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101A PARK ST
ATLANTA TX
75551-2645
US

IV. Provider business mailing address

PO BOX 972
ATLANTA TX
75551-0972
US

V. Phone/Fax

Practice location:
  • Phone: 903-796-1245
  • Fax: 903-796-9935
Mailing address:
  • Phone: 903-796-1245
  • Fax: 903-796-9935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: