MEDICARE: DR. JON GARWOOD TRAXLER 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	207Y00000X	Otolaryngology Physician	09944R	LA
2	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	09944R	LA

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	:	1689663981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON GARWOOD TRAXLER MD

Provider Business Mailing Address
First Line	:	604 N ACADIA RD STE 101
Second Line	:
City	:	THIBODAUX
State	:	LA
Zip	:	70301-4897
Country	:	US
Telephone Number	:	985-446-5079
Fax Number	:	985-447-2497

Provider Business Practice Location Address
First Line	:	8080 BLUEBONNET BLVD
Second Line	:	STE. 2121
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-7827
Country	:	US
Telephone Number	:	225-767-7200
Fax Number	:	225-767-7386

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	03/06/2024

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