Healthcare Provider Details

I. General information

NPI: 1467499384
Provider Name (Legal Business Name): PAMELA C TROUT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N LAKEMONT AVE SUITE 200
WINTER PARK FL
32792-3228
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-203-4410
  • Fax: 321-203-4409
Mailing address:
  • Phone: 321-203-4410
  • Fax: 321-203-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME94271
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME94271
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: