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1154379881 NPI number — GEORGE G TRIM MD

NPI Number: 1154379881
Health Care Provider/Practitioner: GEORGE G TRIM MD

Information about “1154379881” NPI (GEORGE G TRIM MD) exists in 1154379881 in HTML format HTML  |  1154379881 in plain Text format TXT  |  1154379881 in PDF (Portable Document Format) PDF  |  1154379881 in an XML format XML  formats.

NPI Number : 1154379881 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154379881",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TRIM",
    "FirstName": "GEORGE",
    "MiddleName": "G",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "12014 S.W. LAGUNA BAY PARKWAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORT ST. LUCIE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "34987-7755",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "609-709-7185",
    "MailingAddressFaxNumber": "772-448-8829",
    "FirstLinePracticeLocationAddress": "264 NW PEACOCK BLVD.",
    "SecondLinePracticeLocationAddress": "SUITE #103",
    "PracticeLocationAddressCityName": "PORT ST. LUCIE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34986-2272",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "772-204-2562",
    "PracticeLocationAddressFaxNumber": "609-489-4651",
    "EnumerationDate": "05/05/2006",
    "LastUpdateDate": "03/26/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208D00000X",
          "TaxonomyName": "General Practice Physician",
          "LicenseNumber": "MA51879",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "174400000X",
          "TaxonomyName": "Specialist",
          "LicenseNumber": "MA51879",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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