Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 15815 | OR |
NPI | 1013945823 |
---|---|
Provider Name | Robert Joseph Trujillo |
First Address | Medford, OR 97501-0132 |
Second Address | Medford, OR 97504-7134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 23/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
057257 | (05) | OR |
E33785 | (02) |