Provider Demographics
NPI:1821090739
Name:TROUT, COLIN R (MD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:R
Last Name:TROUT
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:PO BOX 43100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3100
Mailing Address - Country:US
Mailing Address - Phone:520-308-5047
Mailing Address - Fax:520-308-5274
Practice Address - Street 1:6127 N LA CHOLLA BLVD STE 175
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3747
Practice Address - Country:US
Practice Address - Phone:520-308-5047
Practice Address - Fax:520-308-5274
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29660207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH52897Medicare UPIN
AZ68087Medicare ID - Type Unspecified