Healthcare Provider Details

I. General information

NPI: 1821093576
Provider Name (Legal Business Name): BRUCE WILLIAMS TROTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2005
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 21ST AVE W
BRADENTON FL
34208
US

IV. Provider business mailing address

5715 21ST AVE W #D
BRADENTON FL
34209
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-1505
  • Fax: 941-748-1552
Mailing address:
  • Phone: 941-761-1800
  • Fax: 941-761-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME84389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: