Provider Demographics
NPI:1841373859
Name:TRAUGH, BRIAN WILLIAM (PA-C)
Entity type:Individual
Prefix:PROF
First Name:BRIAN
Middle Name:WILLIAM
Last Name:TRAUGH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2621 LOSEE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-4129
Mailing Address - Country:US
Mailing Address - Phone:702-295-1473
Mailing Address - Fax:702-295-4323
Practice Address - Street 1:2621 LOSEE RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-4129
Practice Address - Country:US
Practice Address - Phone:702-295-1473
Practice Address - Fax:702-295-4323
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011220363A00000X
GA004959363A00000X
NVPA-C0176363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant