Provider Demographics
NPI:1689663981
Name:TRAXLER, JON GARWOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:GARWOOD
Last Name:TRAXLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:604 N ACADIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4897
Mailing Address - Country:US
Mailing Address - Phone:985-446-5079
Mailing Address - Fax:985-447-2497
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:STE. 2121
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7827
Practice Address - Country:US
Practice Address - Phone:225-767-7200
Practice Address - Fax:225-767-7386
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2024-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA09944R207Y00000X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1971138Medicaid
LA1971138Medicaid
LA5R853Medicare PIN
LAF63080Medicare UPIN