Provider Demographics
NPI:1396210209
Name:TRAUTMANN, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:TRAUTMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E SONTERRA BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3988
Mailing Address - Country:US
Mailing Address - Phone:210-729-1900
Mailing Address - Fax:
Practice Address - Street 1:155 E SONTERRA BLVD STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3988
Practice Address - Country:US
Practice Address - Phone:210-729-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-06
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant