Provider Demographics
NPI:1861457970
Name:TROUSDALE, DEVIN MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:MITCHELL
Last Name:TROUSDALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DEVIN
Other - Middle Name:MITCHELL
Other - Last Name:TROUSDALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-648-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9523207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178013201Medicaid
8G2513Medicare ID - Type Unspecified
TX178013201Medicaid