Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | ME73934 | FL |
N | 2086S0120X | Pediatric Surgery | ME73934 | FL |
NPI | 1033130216 |
---|---|
Provider Name | Mr. Eric Robert Trumble |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Sioux Falls, SD 57104-4650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 19/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
252693000 | (05) | FL |
44549 | BLUE CROSS BLUE SHIELD (01) | FL |