Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 9612 | NV |
N | 207QA0505X | Family Doctor - Adult Medicine | G72275 | CA |
NPI | 1235329194 |
---|---|
Provider Name | Dr. Beth Traylor |
First Address | Las Vegas, NV 89138-6123 |
Second Address | Las Vegas, NV 89145-4882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2007 |
Last Update Date | 06/05/2020 |