Provider Demographics
NPI:1346555802
Name:TRAIL MEDICAL CENTER PA
Entity Type:Organization
Organization Name:TRAIL MEDICAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-BAPTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-687-8685
Mailing Address - Street 1:1266 N MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6015
Mailing Address - Country:US
Mailing Address - Phone:561-687-8685
Mailing Address - Fax:561-683-2279
Practice Address - Street 1:1266 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6015
Practice Address - Country:US
Practice Address - Phone:561-687-8685
Practice Address - Fax:561-683-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty