Provider Demographics
NPI:1548427081
Name:VAN TRUMP, ROBERT R (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:VAN TRUMP
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:ERIN
Mailing Address - State:TN
Mailing Address - Zip Code:37061-0469
Mailing Address - Country:US
Mailing Address - Phone:931-289-4201
Mailing Address - Fax:931-289-4204
Practice Address - Street 1:4891 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ERIN
Practice Address - State:TN
Practice Address - Zip Code:37061-4115
Practice Address - Country:US
Practice Address - Phone:931-289-4201
Practice Address - Fax:931-289-4204
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical