MEDICARE: DR. JACK MARSHALL TRAINOR M.D.

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	207QS0010X	Sports Medicine (Family Medicine) Physician	ME77382	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME77382	OTHER	FL	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033155171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK MARSHALL TRAINOR M.D.

Provider Business Mailing Address
First Line	:	2829 NE 33RD CT
Second Line	:	#405
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-2028
Country	:	US
Telephone Number	:	954-564-5725
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 N FEDERAL HWY
Second Line	:	SUITE A-39
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4608
Country	:	US
Telephone Number	:	954-771-8177
Fax Number	:	954-771-3629

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	07/08/2007

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