Provider Demographics
NPI:1457318032
Name:TROAST, DARRELL LLOYD (DO)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:LLOYD
Last Name:TROAST
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 1:12550 PROFESSIONAL PARK DRIVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913
Mailing Address - Country:US
Mailing Address - Phone:239-768-2111
Mailing Address - Fax:239-482-4404
Practice Address - Street 1:13650 METROPOLIS AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-768-2111
Practice Address - Fax:239-768-2113
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5306208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046705701Medicaid
FLD70557Medicare UPIN
FL80009Medicare ID - Type Unspecified