Provider Demographics
NPI:1609838887
Name:TROTTA, EUGENE THOMAS JR (PA)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:THOMAS
Last Name:TROTTA
Suffix:JR
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 1:1195 GARNER FIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-4820
Mailing Address - Country:US
Mailing Address - Phone:830-278-3086
Mailing Address - Fax:830-278-8873
Practice Address - Street 1:1195 GARNER FIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4820
Practice Address - Country:US
Practice Address - Phone:830-278-3086
Practice Address - Fax:830-278-8873
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01261363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA01261OtherPHYSICIAN ASSISTANT PERMI