MEDICARE: DR. WALTER THOMAS 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	2084P0800X	Psychiatry Physician	13516	OK

General Provider Information

NPI Number	:	1982615068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER THOMAS TRAXLER MD

Provider Business Mailing Address
First Line	:	3012 MILES DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-4112
Country	:	US
Telephone Number	:	405-348-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	LAWTON-FT. SILL VA OUTPATIENT CLINIC
Second Line	:	BLDG 4303 PITMAN AND THOMAS
City	:	FORT STILL
State	:	OK
Zip	:	73503
Country	:	US
Telephone Number	:	580-353-1131
Fax Number	:	580-353-0340

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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