Healthcare Provider Details

I. General information

NPI: 1750358263
Provider Name (Legal Business Name): WILLIAM CLIFTON TROUT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 NORTH ST
MEADVILLE PA
16335-3322
US

IV. Provider business mailing address

217 NORTH ST
MEADVILLE PA
16335-3322
US

V. Phone/Fax

Practice location:
  • Phone: 814-333-9196
  • Fax: 814-333-9196
Mailing address:
  • Phone: 814-333-9196
  • Fax: 814-333-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC002086L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: