MEDICARE: THOMAS K TRAUBA

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	208VP0000X	Pain Medicine Physician	174956-1205	UT

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	:	1891793147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS K TRAUBA

Provider Business Mailing Address
First Line	:	PO BOX 27688
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0688
Country	:	US
Telephone Number	:	801-534-1360
Fax Number	:	801-366-9883

Provider Business Practice Location Address
First Line	:	3838 S 700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-1496
Country	:	US
Telephone Number	:	801-261-4988
Fax Number	:	801-269-9427

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	05/05/2008

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Directions to “ THOMAS K TRAUBA ” Practice Location

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