Provider Demographics
NPI:1508312349
Name:JAMES R TRAHAN MD PLC
Entity Type:Organization
Organization Name:JAMES R TRAHAN MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:TRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-292-2150
Mailing Address - Street 1:2521 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE #122
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8629
Mailing Address - Country:US
Mailing Address - Phone:515-292-2150
Mailing Address - Fax:515-292-2184
Practice Address - Street 1:2521 UNIVERSITY BLVD
Practice Address - Street 2:SUITE #122
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8629
Practice Address - Country:US
Practice Address - Phone:515-292-2150
Practice Address - Fax:515-292-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27031251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAE03971Medicare UPIN