Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 00717 | IA |
NPI | 1083603278 |
---|---|
Provider Name | Dr. Bryan Mathew Trout |
First Address | Des Moines, IA 50314-3045 |
Second Address | Ankeny, IA 50021-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 15/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0210443 | (05) | IA |
I7693 | MEDICARE GROUP ID# (01) | IA |
U80406 | (02) | IA |