Provider Demographics
NPI:1639185739
Name:TRAEGER, MARC STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:STEVEN
Last Name:TRAEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:WHITERIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85941-0860
Mailing Address - Country:US
Mailing Address - Phone:928-338-4911
Mailing Address - Fax:
Practice Address - Street 1:801 ENCINO PL NE STE 14
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-272-1777
Practice Address - Fax:505-272-2360
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17404207Q00000X
NMMD2018-0258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1629236716Medicaid
AZ1295993376Medicaid
AZ1780614008Medicaid
AZ1871523191Medicaid
AZ409715Medicaid
AZ8HBE84Medicare ID - Type UnspecifiedWHITERIVER
AZ1295993376Medicaid
AZ8HBE85Medicare ID - Type UnspecifiedCIBECUE