MEDICARE: THOMAS R TRAYLOR 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	207V00000X	Obstetrics & Gynecology Physician	MD13236	TN

General Provider Information

NPI Number	:	1144223447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS R TRAYLOR MD

Provider Business Mailing Address
First Line	:	939 E EMERALD AVE
Second Line	:	STE 901
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4540
Country	:	US
Telephone Number	:	865-546-9623
Fax Number	:	865-971-4887

Provider Business Practice Location Address
First Line	:	939 E EMERALD AVE
Second Line	:	STE 901
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4540
Country	:	US
Telephone Number	:	865-546-9623
Fax Number	:	865-971-4887

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/24/2010

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