Provider Demographics
NPI:1922004886
Name:TRAMMELL, STEPHEN BRUCE (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BRUCE
Last Name:TRAMMELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1669
Mailing Address - Country:US
Mailing Address - Phone:972-617-6376
Mailing Address - Fax:972-617-6381
Practice Address - Street 1:675 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OVILLA
Practice Address - State:TX
Practice Address - Zip Code:75154-1669
Practice Address - Country:US
Practice Address - Phone:972-617-6376
Practice Address - Fax:972-617-6381
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E23581Medicare UPIN
TX8F6730Medicare PIN