1538683941 NPI number — MR. DANIEL RAY TRAUTMAN MA 60320064

Table of content: MR. DANIEL RAY TRAUTMAN MA 60320064 (NPI 1538683941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538683941 NPI number — MR. DANIEL RAY TRAUTMAN MA 60320064

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAUTMAN
Provider First Name:
DANIEL
Provider Middle Name:
RAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA 60320064
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538683941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12015 SE 213TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98031-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-290-1958
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1760 NEWPORT WAY NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027-5354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-998-6542
Provider Business Practice Location Address Fax Number:
425-332-7071
Provider Enumeration Date:
07/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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