Individual
JACK R TRAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 HAL GREER BOULEVARD, HUNTINGTON, WV 25701-3656
(304) 399-6609
(304) 399-6621
Mailing address
1400 HAL GREER BOULEVARD, HUNTINGTON, WV 25701-3656
(304) 399-6556
(304) 399-6554
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
12969
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0128350000
—
WV
05
—
0491258
—
OH
05
—
64694771
—
KY
Enumeration date
03/23/2006
Last updated
05/03/2021
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