MEDICARE: DAVID BENJAMIN TRAYLOR ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AT1930	TX

General Provider Information

NPI Number	:	1023225034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BENJAMIN TRAYLOR ATC

Provider Business Mailing Address
First Line	:	5104 ROUNDTREE CT
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2194
Country	:	US
Telephone Number	:	817-744-2051
Fax Number	:	817-744-2254

Provider Business Practice Location Address
First Line	:	9450 RAY WHITE RD
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-6110
Country	:	US
Telephone Number	:	817-744-2051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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