Provider Demographics
NPI:1578632618
Name:EDWARD S. TRUPPMAN M.D., P.A.
Entity Type:Organization
Organization Name:EDWARD S. TRUPPMAN M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:TRUPPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-888-1821
Mailing Address - Street 1:PO BOX 630188
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33163-0188
Mailing Address - Country:US
Mailing Address - Phone:954-888-1821
Mailing Address - Fax:954-888-1832
Practice Address - Street 1:12575 ORANGE DR
Practice Address - Street 2:301
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4302
Practice Address - Country:US
Practice Address - Phone:954-888-1821
Practice Address - Fax:954-888-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME6908174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD59287Medicare UPIN
FL90615Medicare ID - Type Unspecified