Provider Demographics
NPI:1598808669
Name:TRAYLOR, JUSTON DON
Entity Type:Individual
Prefix:MR
First Name:JUSTON
Middle Name:DON
Last Name:TRAYLOR
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 1:225 GAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-6323
Mailing Address - Country:US
Mailing Address - Phone:740-670-0959
Mailing Address - Fax:
Practice Address - Street 1:225 GAY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-6323
Practice Address - Country:US
Practice Address - Phone:740-670-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2625878OtherI.H.P.