Provider Demographics
NPI:1528234218
Name:JAMES RAY TRAHAN MD PLC
Entity type:Organization
Organization Name:JAMES RAY TRAHAN MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:TRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-292-2150
Mailing Address - Street 1:2521 UNIVERSITY BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8629
Mailing Address - Country:US
Mailing Address - Phone:515-292-2150
Mailing Address - Fax:515-292-2184
Practice Address - Street 1:2521 UNIVERSITY BLVD STE 122
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8629
Practice Address - Country:US
Practice Address - Phone:515-292-2150
Practice Address - Fax:515-292-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27031251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAE03971Medicare UPIN