Provider Demographics
NPI:1396002259
Name:TROSS, LOREN E (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:E
Last Name:TROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LOREN
Other - Middle Name:E
Other - Last Name:WALWYN-TROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:EVANS ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:1650 COCHRANE CIR B7500
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4613
Mailing Address - Country:US
Mailing Address - Phone:719-526-1910
Mailing Address - Fax:719-526-7732
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4613
Practice Address - Country:US
Practice Address - Phone:719-526-7708
Practice Address - Fax:719-526-7732
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE27480208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program