Provider Demographics
NPI:1629182431
Name:THEODORE JOSEPH TRUMBLE II MD PA
Entity Type:Organization
Organization Name:THEODORE JOSEPH TRUMBLE II MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:TRUMBLE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:281-734-9268
Mailing Address - Street 1:PO BOX 2507
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77252-2507
Mailing Address - Country:US
Mailing Address - Phone:281-734-9268
Mailing Address - Fax:713-218-7635
Practice Address - Street 1:7887 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2013
Practice Address - Country:US
Practice Address - Phone:281-734-9268
Practice Address - Fax:713-218-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1150207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0019PSOtherBLUE CROSS BLUE SHIELD
TX189501301Medicaid
TX0019PSOtherBLUE CROSS BLUE SHIELD
TXF99525Medicare UPIN