Provider Demographics
NPI:1164402301
Name:TRIMMER, KENNETH J (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:TRIMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 COIT RD
Mailing Address - Street 2:#290
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6200 W PARKER RD
Practice Address - Street 2:#302
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7939
Practice Address - Country:US
Practice Address - Phone:972-473-6216
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7517207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE35106Medicare UPIN