Healthcare Provider Details

I. General information

NPI: 1073564399
Provider Name (Legal Business Name): JAIME E TRUJILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 TRENWEST DR
WINSTON SALEM NC
27103-3223
US

IV. Provider business mailing address

3801 N LAKESHORE DR
CLEMMONS NC
27012-8416
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-0496
  • Fax: 336-768-0498
Mailing address:
  • Phone: 336-766-4951
  • Fax: 336-766-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number21447
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21447
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: