Healthcare Provider Details

I. General information

NPI: 1730301037
Provider Name (Legal Business Name): JAIME E TRUJILLO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 TRENWEST DRIVE
WINSTON SALEM NC
27103
US

IV. Provider business mailing address

3080 TRENWEST DRIVE
WINSTON SALEM NC
27103
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAIME E TRUJILL0
Title or Position: PRESIDENT
Credential: MD
Phone: 336-768-0496