MEDICARE: MARK WILLIAM TRAUGH P.A.

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	363AM0700X	Medical Physician Assistant	PA558	TN

General Provider Information

NPI Number	:	1558340026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK WILLIAM TRAUGH P.A.

Provider Business Mailing Address
First Line	:	1804 HIGHWAY 45 BYP
Second Line	:	SUITE 604
City	:	JACKSON
State	:	TN
Zip	:	38305-4436
Country	:	US
Telephone Number	:	731-660-8759
Fax Number	:	731-660-8739

Provider Business Practice Location Address
First Line	:	708 W FOREST AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3901
Country	:	US
Telephone Number	:	731-425-6280
Fax Number	:	731-425-4922

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	07/08/2007

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Directions to “ MARK WILLIAM TRAUGH P.A.” Practice Location

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