MEDICARE: MR. DAN TRIMBLE M.S., FAAA

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	231H00000X	Audiologist	DA4516	AZ

General Provider Information

NPI Number	:	1740301399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAN TRIMBLE M.S., FAAA

Provider Business Mailing Address
First Line	:	13934 N 59TH AVE
Second Line	:	SUITE 120
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4167
Country	:	US
Telephone Number	:	602-866-0147
Fax Number	:

Provider Business Practice Location Address
First Line	:	13934 N 59TH AVE
Second Line	:	SUITE 120
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4167
Country	:	US
Telephone Number	:	602-866-0147
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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