MEDICARE: EDWARD R. TROBAUGH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD154383	OR

General Provider Information

NPI Number	:	1194968800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD R. TROBAUGH MD

Provider Business Mailing Address
First Line	:	PO BOX 2120
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-2120
Country	:	US
Telephone Number	:	541-274-8400
Fax Number	:	541-274-8405

Provider Business Practice Location Address
First Line	:	2821 DAGGETT AVE STE 200
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1130
Country	:	US
Telephone Number	:	541-274-8400
Fax Number	:	541-274-8405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2009
Last Update Date	:	03/03/2023

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