Provider Demographics
NPI:1922056597
Name:TRIMBLE, RODNEY B (DO)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:B
Last Name:TRIMBLE
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 1:5815 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-7107
Mailing Address - Country:US
Mailing Address - Phone:281-543-9458
Mailing Address - Fax:281-543-9458
Practice Address - Street 1:1708 ELMEN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-5702
Practice Address - Country:US
Practice Address - Phone:281-543-9458
Practice Address - Fax:281-543-9458
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116880906Medicaid
TX1168809-05Medicaid