Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 01051309A | IN |
NPI | 1538187950 |
---|---|
Provider Name | Scott J Trumble |
First Address | Elkhart, IN 46514-1228 |
Second Address | Elkhart, IN 46514-1228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 02/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200242070A | (05) | IN |
H02927 | (02) |