Basic Information
| Provider Information | |||||||||
| NPI: | 1669577060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAYNOR | ||||||||
| FirstName: | ARCHIE | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 SW 160TH AVE | ||||||||
| Address2: | SUITE #250 | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330276308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058669951 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3601 SW 160TH AVE | ||||||||
| Address2: | SUITE #250 | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330276308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058669951 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 03/04/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS3779 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | OS3779 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 272609200 | 05 | FL | MEDICAID |