MEDICARE: DR. GARY S. TRAUB PH.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	103TC0700X	Clinical Psychologist	PY3620	FL

General Provider Information

NPI Number	:	1295822674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY S. TRAUB PH.D.

Provider Business Mailing Address
First Line	:	6000 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-2226
Country	:	US
Telephone Number	:	954-202-6200
Fax Number	:	954-202-6207

Provider Business Practice Location Address
First Line	:	6000 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-2226
Country	:	US
Telephone Number	:	954-202-6200
Fax Number	:	954-202-6207

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	03/03/2012

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