Provider Demographics
NPI:1518974013
Name:TRAYNOR, ROBERT M (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:TRAYNOR
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7416 VARDON WAY
Mailing Address - Street 2:
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8866
Mailing Address - Country:US
Mailing Address - Phone:970-282-0702
Mailing Address - Fax:
Practice Address - Street 1:4675 W 20TH STREET RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3246
Practice Address - Country:US
Practice Address - Phone:970-352-2881
Practice Address - Fax:970-352-5323
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CON/A231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07104193Medicaid
CO07104193Medicaid