Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | G33987 | CA |
NPI | 1013917939 |
---|---|
Provider Name | Craig Traugott |
First Address | Redding, CA 96049-6084 |
Second Address | Redding, CA 96001-2509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 30/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G339871 | (05) | CA |
G35657 | (02) | CA |