Provider Demographics
NPI:1063648426
Name:TRPKOSH, TROY A (CCP)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:A
Last Name:TRPKOSH
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8218
Mailing Address - Country:US
Mailing Address - Phone:903-535-5011
Mailing Address - Fax:903-535-5000
Practice Address - Street 1:312 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8218
Practice Address - Country:US
Practice Address - Phone:903-535-5011
Practice Address - Fax:903-535-5000
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF0145242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist