Provider Demographics
NPI:1073615126
Name:TRAUTWEIN, ERIC P (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:P
Last Name:TRAUTWEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 E CABRILLO BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2884
Mailing Address - Country:US
Mailing Address - Phone:805-969-4025
Mailing Address - Fax:805-565-8926
Practice Address - Street 1:1805 E CABRILLO BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-2884
Practice Address - Country:US
Practice Address - Phone:805-969-4025
Practice Address - Fax:805-565-8926
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI24281Medicare UPIN
CAWA82126BMedicare PIN