Provider Demographics
NPI:1891766820
Name:TRUBSCHENCK, ERIC W (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:W
Last Name:TRUBSCHENCK
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 1:917 E FIR AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7919
Mailing Address - Country:US
Mailing Address - Phone:805-736-2510
Mailing Address - Fax:805-736-4224
Practice Address - Street 1:917 E FIR AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7919
Practice Address - Country:US
Practice Address - Phone:805-736-2510
Practice Address - Fax:805-736-4224
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG347622085R0202X
KY393152085R0202X
MA2236042085R0202X
PAMD4256992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000358791OtherBLUE CROSS/BLUE SHIELD
KY64096977Medicaid
KY0903640Medicare PIN
KY0691685Medicare PIN
KY000000358791OtherBLUE CROSS/BLUE SHIELD
KY0935318Medicare PIN
KYP00236547Medicare PIN