Healthcare Provider Details

I. General information

NPI: 1780879643
Provider Name (Legal Business Name): GERAD A TROUTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415
US

IV. Provider business mailing address

4013 111TH ST
LUBBOCK TX
79423-0897
US

V. Phone/Fax

Practice location:
  • Phone: 806-775-9700
  • Fax:
Mailing address:
  • Phone: 940-642-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT-2035
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberN8863
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN8863
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: