Provider Demographics
NPI:1073564399
Name:TRUJILLO, JAIME E (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:E
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3801 N LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8416
Mailing Address - Country:US
Mailing Address - Phone:336-766-4951
Mailing Address - Fax:336-766-4951
Practice Address - Street 1:3080 TRENWEST DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3223
Practice Address - Country:US
Practice Address - Phone:336-768-0496
Practice Address - Fax:336-768-0498
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC21447207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8983880Medicaid
NC8983880Medicaid
NCC81057Medicare UPIN