1821093576 NPI number — BRUCE WILLIAMS TROTMAN MD

Table of content: BRUCE WILLIAMS TROTMAN MD (NPI 1821093576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821093576 NPI number — BRUCE WILLIAMS TROTMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROTMAN
Provider First Name:
BRUCE
Provider Middle Name:
WILLIAMS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821093576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5715 21ST AVE W #D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-761-1800
Provider Business Mailing Address Fax Number:
941-761-1883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5715 21ST AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-748-1505
Provider Business Practice Location Address Fax Number:
941-748-1552
Provider Enumeration Date:
06/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  ME84389 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 78606 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5464508 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00149431 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 200793285001 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 292062 . This is a "AMERIGROUP VA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: AA53213 . This is a "HARVARD PILGRIM HPHC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 226281 . This is a "STAYWELL HEALTHEASE WELLC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7766973 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 115965 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 271368300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 463979 . This is a "AMERIHEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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