Provider Demographics
NPI:1124019609
Name:TRAYNOR, PHILIP M (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:M
Last Name:TRAYNOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:VINEMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35179-0088
Mailing Address - Country:US
Mailing Address - Phone:256-878-0971
Mailing Address - Fax:
Practice Address - Street 1:9625 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-0129
Practice Address - Country:US
Practice Address - Phone:256-878-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL140213E00000X
TX1219213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000074415Medicaid
AL51074415OtherBCBS
TX136479605Medicaid
AL000074442Medicare ID - Type UnspecifiedFAULKVILLE
AL000074994Medicare ID - Type UnspecifiedGADSDEN
AL000074415Medicaid
TX00L63NMedicare ID - Type UnspecifiedJACKSBORO, TX
AL000074415Medicare ID - Type UnspecifiedOFFICE
ALU35203Medicare UPIN