Provider Demographics
NPI:1417121286
Name:TRUMBLY, ALAN RAY (DO)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:RAY
Last Name:TRUMBLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 EAST PRESIDENT GEORGE BUSH FREEWAY
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082
Mailing Address - Country:US
Mailing Address - Phone:469-204-6100
Mailing Address - Fax:469-204-6194
Practice Address - Street 1:2805 E PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3561
Practice Address - Country:US
Practice Address - Phone:469-204-6100
Practice Address - Fax:469-204-6194
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8393207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215079901Medicaid
TXTXB105793Medicare PIN