Provider Demographics
NPI:1043596521
Name:TRAUGOTT, KIM THERESA (DVM)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:THERESA
Last Name:TRAUGOTT
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17740 SABAL PALM DR
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-2219
Mailing Address - Country:US
Mailing Address - Phone:631-827-6399
Mailing Address - Fax:
Practice Address - Street 1:17740 SABAL PALM DR
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-2219
Practice Address - Country:US
Practice Address - Phone:631-827-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLVM11167174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian