Healthcare Provider Details

I. General information

NPI: 1285825018
Provider Name (Legal Business Name): TROY I MOUNTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SAN PALO RD
ATASCADERO CA
93422-2481
US

IV. Provider business mailing address

PO BOX 1737
SAN LUIS OBISPO CA
93406-1737
US

V. Phone/Fax

Practice location:
  • Phone: 805-544-2500
  • Fax: 805-544-0832
Mailing address:
  • Phone: 805-544-2500
  • Fax: 805-544-0832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA132322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: