Provider Demographics
NPI:1417959347
Name:TRIMBLE, C DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:DAVID
Last Name:TRIMBLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W RUSS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-2457
Mailing Address - Country:US
Mailing Address - Phone:937-548-1244
Mailing Address - Fax:
Practice Address - Street 1:415 W RUSS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-2457
Practice Address - Country:US
Practice Address - Phone:937-548-1244
Practice Address - Fax:937-548-8898
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-1970T213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0468113Medicaid
OHT95754Medicare UPIN
OHTR0502061Medicare ID - Type Unspecified
OH0468113Medicaid