Provider Demographics
NPI:1760514038
Name:TRAWNIK, ROBERT TERRY (BCO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:TERRY
Last Name:TRAWNIK
Suffix:
Gender:M
Credentials:BCO
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 972
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-0972
Mailing Address - Country:US
Mailing Address - Phone:903-796-1245
Mailing Address - Fax:903-796-9935
Practice Address - Street 1:101A PARK ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-2645
Practice Address - Country:US
Practice Address - Phone:903-796-1245
Practice Address - Fax:903-796-9935
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1968803Medicaid
TX0875114-01Medicaid
TX0875114-01Medicaid
LA1968803Medicaid