Provider Demographics
NPI:1275566671
Name:TRASKA, HENRY C JR (DPM)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:C
Last Name:TRASKA
Suffix:JR
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 1:2416 WEST PARK ROW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-3304
Mailing Address - Country:US
Mailing Address - Phone:817-274-3303
Mailing Address - Fax:817-274-3346
Practice Address - Street 1:2416 WEST PARK ROW DRIVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-3304
Practice Address - Country:US
Practice Address - Phone:817-274-3303
Practice Address - Fax:817-274-3346
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0737213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT16330Medicare UPIN
TX00NR54Medicare PIN