Provider Demographics
NPI:1427002930
Name:TROTTIER, RORY DWAIN (MD)
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:DWAIN
Last Name:TROTTIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4010
Mailing Address - Country:US
Mailing Address - Phone:701-738-2004
Mailing Address - Fax:
Practice Address - Street 1:2810 17TH AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4010
Practice Address - Country:US
Practice Address - Phone:701-738-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8135207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10836Medicaid
ND0704690OtherMEDICA
NDNA4511021933OtherPREFERREDONE
ND20300523558201A002OtherTRICARE
ND026493OtherBCBSND
ND859517800OtherMN MEDICAL ASSISTANCE
NDG43353Medicare UPIN
ND026493OtherBCBSND