Provider Demographics
NPI:1669663332
Name:D. A. TRAUB & CO., INC.
Entity Type:Organization
Organization Name:D. A. TRAUB & CO., INC.
Other - Org Name:HERITAGE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-494-9994
Mailing Address - Street 1:7614 E 91ST ST
Mailing Address - Street 2:STE 180
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6047
Mailing Address - Country:US
Mailing Address - Phone:918-494-9994
Mailing Address - Fax:918-494-9745
Practice Address - Street 1:7614 E 91ST ST
Practice Address - Street 2:STE 180
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6047
Practice Address - Country:US
Practice Address - Phone:918-494-9994
Practice Address - Fax:918-494-9745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center