Healthcare Provider Details

I. General information

NPI: 1508978032
Provider Name (Legal Business Name): JAY R TRABIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 SE GOLDTREE DR STE D
PORT SAINT LUCIE FL
34952-7563
US

IV. Provider business mailing address

8645 N MILITARY TRAIL SUITE 508
PALM BEACH GARDENS FL
33410-6296
US

V. Phone/Fax

Practice location:
  • Phone: 772-800-7001
  • Fax: 772-877-3539
Mailing address:
  • Phone: 561-630-8001
  • Fax: 844-971-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0030448
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: