Healthcare Provider Details

I. General information

NPI: 1962643668
Provider Name (Legal Business Name): RICHARD E TROWBRIDGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 SCOTT CIRCLE 15TH MDG
JBPH-HICKAM HI
96853
US

IV. Provider business mailing address

755 SCOTT CIRCLE 15TH MDG
JBPH-HICKAM HI
96853
US

V. Phone/Fax

Practice location:
  • Phone: 808-448-3446
  • Fax:
Mailing address:
  • Phone: 808-448-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01068485A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: