Provider Demographics
NPI:1821091182
Name:TRUBOWITSCH, GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:TRUBOWITSCH
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 1:1700 CURIE
Mailing Address - Street 2:SUITE #3800
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-532-3912
Mailing Address - Fax:915-542-3436
Practice Address - Street 1:1700 CURIE DR
Practice Address - Street 2:STE 3800
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2985
Practice Address - Country:US
Practice Address - Phone:915-532-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2822207W00000X, 207WX0107X
NM92-368207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047248201Medicaid
NM180020531Medicare PIN
TX180020531Medicare PIN
TX890859Medicare PIN
TX047248201Medicaid