MEDICARE: DR. WANWISA YAMFANG TROMBLEY M.D.

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	L7768	TX

General Provider Information

NPI Number	:	1780621094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WANWISA YAMFANG TROMBLEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9101
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-9494
Country	:	US
Telephone Number	:	972-745-7500
Fax Number	:	972-745-4336

Provider Business Practice Location Address
First Line	:	14856 PRESTON RD
Second Line	:	SUITE #100
City	:	DALLAS
State	:	TX
Zip	:	75254-6822
Country	:	US
Telephone Number	:	972-387-8900
Fax Number	:	972-661-9868

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	05/21/2014

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