Provider Demographics
NPI:1558428581
Name:TRIMBLE, MICHAEL ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:TRIMBLE
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 1:1514 GOLDRUSH RD
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8375
Mailing Address - Country:US
Mailing Address - Phone:928-704-6070
Mailing Address - Fax:928-704-6072
Practice Address - Street 1:1514 GOLDRUSH RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8375
Practice Address - Country:US
Practice Address - Phone:928-704-6070
Practice Address - Fax:928-704-6072
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33104208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4543437OtherAETNA
AZ874679002OtherARIZONA PHYSICIANS IPA
AZ874679OtherHEALTH CHOICE AZ
AZ1414832OtherAETNA HMO
AZ2Z5220OtherHEALTH NET OF AZ
AZAZ0762251OtherBCBS
AZ874679Medicaid
C64255Medicare UPIN
AZ874679Medicaid
AZAZ0762251OtherBCBS
AZ112807Medicare PIN