Provider Demographics
NPI:1679560395
Name:SARGENT, TROY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:ALAN
Last Name:SARGENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5220 BELFORT RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6017
Mailing Address - Country:US
Mailing Address - Phone:904-446-3451
Mailing Address - Fax:904-446-3013
Practice Address - Street 1:2200 RANDALLIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4638
Practice Address - Country:US
Practice Address - Phone:260-373-4433
Practice Address - Fax:260-737-6704
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301052791208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
10785765OtherCAQH PROVIDER ID
381303843OtherTAX ID
MI4879960Medicaid
MI4879960Medicaid
182170Medicare ID - Type Unspecified