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NPI Code Detail

MEDICARE: THEODORE JOSEPH TRUMBLE II MD PA

MEDICARE: THEODORE JOSEPH TRUMBLE II MD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0300XGeriatric Medicine (Internal Medicine) PhysicianJ1150TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10019PSOTHERTXBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629182431
Entity Type Code : Organization
Provider Name (Legal Business Name) : THEODORE JOSEPH TRUMBLE II MD PA
Provider Business Mailing Address
First Line : PO BOX 2507
Second Line :
City : HOUSTON
State : TX
Zip : 77252-2507
Country : US
Telephone Number : 281-734-9268
Fax Number : 713-218-7635
Provider Business Practice Location Address
First Line : 7887 CAMBRIDGE ST
Second Line :
City : HOUSTON
State : TX
Zip : 77054-2013
Country : US
Telephone Number : 281-734-9268
Fax Number : 713-218-7635
Authorized Official
Title or Position : OWNER
Name : DR. THEODORE JOSEPH TRUMBLE II
Credential : M.D.
Telephone Number : 281-734-9268
Provider Enumeration Date : 08/18/2006
Last Update Date : 06/10/2009

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