Provider Demographics
NPI:1730301037
Name:JAIME E TRUJILLO MD PA
Entity Type:Organization
Organization Name:JAIME E TRUJILLO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:E
Authorized Official - Last Name:TRUJILL0
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-768-0496
Mailing Address - Street 1:3080 TRENWEST DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-768-0496
Mailing Address - Fax:336-768-0498
Practice Address - Street 1:3080 TRENWEST DRIVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-768-0496
Practice Address - Fax:336-768-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2344340Medicare ID - Type UnspecifiedGROUP NUMBER