Provider Demographics
NPI:1568653756
Name:TROTT-GREGORIO, AMANDA A (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:A
Last Name:TROTT-GREGORIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:A
Other - Last Name:TROTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:255 E SONTERRA BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4076
Mailing Address - Country:US
Mailing Address - Phone:210-888-1297
Mailing Address - Fax:210-888-1285
Practice Address - Street 1:255 E SONTERRA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4076
Practice Address - Country:US
Practice Address - Phone:210-888-1297
Practice Address - Fax:210-888-1285
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN75942080P0201X, 207K00000X
TXBP1-0029100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124399092OtherNPI TYPE 2 GROUP
4665454675OtherMYUTMB 4665454675
TX1124399092OtherNPI TYPE 2 GROUP