Provider Demographics
NPI:1114079050
Name:TRAYLOR, RONALD (PA-C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:TRAYLOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 G ST STE F
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0978
Mailing Address - Country:US
Mailing Address - Phone:209-349-8459
Mailing Address - Fax:209-349-8150
Practice Address - Street 1:3349 G ST STE F
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0978
Practice Address - Country:US
Practice Address - Phone:209-723-3704
Practice Address - Fax:209-723-0272
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU097ZMedicare PIN
CAAU097YMedicare PIN