Healthcare Provider Details

I. General information

NPI: 1194968800
Provider Name (Legal Business Name): EDWARD R. TROBAUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 DAGGETT AVE STE 200
KLAMATH FALLS OR
97601-1130
US

IV. Provider business mailing address

PO BOX 2120
PORTLAND OR
97208-2120
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-8400
  • Fax: 541-274-8405
Mailing address:
  • Phone: 541-274-8400
  • Fax: 541-274-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD154383
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: