Provider Demographics
NPI:1417007618
Name:TRAYLOR AND FIELDS, MD PC
Entity Type:Organization
Organization Name:TRAYLOR AND FIELDS, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-546-9623
Mailing Address - Street 1:939 EMERALD AVE
Mailing Address - Street 2:SUITE 901
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4502
Mailing Address - Country:US
Mailing Address - Phone:865-546-9623
Mailing Address - Fax:865-971-4887
Practice Address - Street 1:939 EMERALD AVE
Practice Address - Street 2:SUITE 901
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4502
Practice Address - Country:US
Practice Address - Phone:865-546-9623
Practice Address - Fax:865-971-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13236207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3711767Medicare ID - Type Unspecified