Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 247817 | MA |
N | 111NI0900X | Internist | 247817 | MA |
N | 207RA0401X | Internist - Addiction Medicine | 247817 | MA |
Y | 207RA0401X | Internist - Addiction Medicine | 4301109196 | MI |
N | 207RI0200X | Infectious Disease | 247817 | MA |
N | 207RI0200X | Infectious Disease | 4301109196 | MI |
NPI | 1205098803 |
---|---|
Provider Name | Paul A Trowbridge |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-4224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 10/09/2021 |