Provider Demographics
NPI:1356841480
Name:TRUMBULL, DANIEL LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:TRUMBULL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 KIRKLAND RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1938
Mailing Address - Country:US
Mailing Address - Phone:419-262-1893
Mailing Address - Fax:
Practice Address - Street 1:2121 HUGHES DR STE 710
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3845
Practice Address - Country:US
Practice Address - Phone:419-291-2671
Practice Address - Fax:419-291-2680
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005487RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant