Provider Demographics
NPI:1770681967
Name:TRIMBLE, MONTY V (MD)
Entity Type:Individual
Prefix:
First Name:MONTY
Middle Name:V
Last Name:TRIMBLE
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 1:3455 LOCKE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5719
Mailing Address - Country:US
Mailing Address - Phone:817-529-6200
Mailing Address - Fax:817-529-6205
Practice Address - Street 1:3455 LOCKE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5719
Practice Address - Country:US
Practice Address - Phone:817-529-6200
Practice Address - Fax:817-529-6205
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4150174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7679401OtherAETNA
TX166931901Medicaid
TX8G2130OtherBCBS OF TEXAS
TX7679401OtherAETNA
TX166931901Medicaid