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General NPI Number Information
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NPI Number | 1568955912
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Entity Type | Individual
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Provider Name | ELIZABETH JOYCE TROUT MD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 19485 OLD JETTON RD STE 100
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City | CORNELIUS
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State | NC
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Zip | 28031-6583
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Country | US
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Telephone | 704-316-5170
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Fax | 704-316-5172
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME150698
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2020-00145
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License Number State | NC
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