Provider Demographics
NPI:1669473690
Name:TRABANINO, J GUILLERMO (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:GUILLERMO
Last Name:TRABANINO
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 1:1111 HIGHWAY 6
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4914
Mailing Address - Country:US
Mailing Address - Phone:281-491-9779
Mailing Address - Fax:281-491-3551
Practice Address - Street 1:1111 HIGHWAY 6
Practice Address - Street 2:SUITE 105
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4914
Practice Address - Country:US
Practice Address - Phone:281-491-9779
Practice Address - Fax:281-491-3551
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF8707207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100017209OtherRAILROAD
TX124580507Medicaid
TX8F8811OtherBLUE CROSS BLUE SHIELD TX
TX8477B1Medicare ID - Type UnspecifiedMEDICARE-FORT BEND COUNTY
TX8451B3Medicare ID - Type UnspecifiedMEDICARE-HARRIS COUNTY
TXD69197Medicare UPIN