Provider Demographics
NPI:1740220102
Name:TRUJILLO, DWAYNE ERNEST (MD)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:ERNEST
Last Name:TRUJILLO
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 1:9500 INDEPENDENCE DR. #700
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507
Mailing Address - Country:US
Mailing Address - Phone:907-569-3600
Mailing Address - Fax:907-569-3200
Practice Address - Street 1:9500 INDEPENDENCE DR. #700
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507
Practice Address - Country:US
Practice Address - Phone:907-569-3600
Practice Address - Fax:907-569-3200
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKG05226Medicare UPIN