MEDICARE: AMATER ZEALE TRAYLOR JR. MD

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	207W00000X	Ophthalmology Physician	C32496	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033178876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMATER ZEALE TRAYLOR JR. MD

Provider Business Mailing Address
First Line	:	5682 ADELINE STREET
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-2804
Country	:	US
Telephone Number	:	510-655-5385
Fax Number	:	510-594-0121

Provider Business Practice Location Address
First Line	:	5682 ADELINE STREET
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-2804
Country	:	US
Telephone Number	:	510-655-5385
Fax Number	:	510-601-9351

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	11/07/2012

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