Healthcare Provider Details

I. General information

NPI: 1598167033
Provider Name (Legal Business Name): GILBERT LEWIS TROUT III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 PIPER ST SUITE T-100
ANCHORAGE AK
99508-4624
US

IV. Provider business mailing address

PO BOX 200149
ANCHORAGE AK
99520-0149
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-3211
  • Fax: 907-562-7547
Mailing address:
  • Phone: 907-561-3211
  • Fax: 907-562-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103880
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: