Provider Demographics
NPI:1144223447
Name:TRAYLOR, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:TRAYLOR
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 1:939 E EMERALD AVE
Mailing Address - Street 2:STE 901
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4540
Mailing Address - Country:US
Mailing Address - Phone:865-546-9623
Mailing Address - Fax:865-971-4887
Practice Address - Street 1:939 E EMERALD AVE
Practice Address - Street 2:STE 901
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4540
Practice Address - Country:US
Practice Address - Phone:865-546-9623
Practice Address - Fax:865-971-4887
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD13236207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB04243Medicare UPIN