Individual
ROGER B TRAYCOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2901 OLD JACKSONVILLE RD, SPRINGFIELD, IL 62704-7437
(217) 698-9722
(217) 391-0392
Mailing address
PO BOX 500, CHATHAM, IL 62629-0500
(217) 670-2424
(217) 670-2809
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036051951
IL
207RR0500X
Rheumatology Physician
Primary
036051951
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020057300
BLACK LUNG
IL
01
—
029224
HEALTH ALLIANCE
IL
01
—
036051951
IL STATE LICENSE
IL
05
—
036051951
—
IL
01
—
08421024
BC/BS
IL
01
—
133586700
ACS-OWCP
IL
01
—
14D0949277
CLIA
IL
01
—
194883
PERSONAL CARE
IL
01
—
206164
HEALTHLINK
IL
01
—
CATERPILLAR
6394P
IL
01
—
CD7143
RR MEDICARE GROUP
IL
01
—
P00144541
RR MEDICARE PIN
IL
Enumeration date
08/09/2006
Last updated
12/16/2011
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