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General NPI Number Information
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NPI Number | 1972602902
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Entity Type | Individual
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Provider Name | SHAWN D. TRASK M.D
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 05/04/2020
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Provider Practice Location Address
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Address Line | 8104 SEATON PL
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City | MONTGOMERY
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State | AL
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Zip | 36116-7204
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Country | US
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Telephone | 334-272-3889
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Fax | 334-272-4089
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Provider Business Mailing Address
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Address Line | 8104 SEATON PL
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City | MONTGOMERY
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State | AL
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Zip | 36116-7204
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Country | US
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Telephone | 334-272-3889
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Fax | 334-272-4089
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | TP873
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20926
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 33419
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License Number State | AL
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