Provider Demographics
NPI:1255891024
Name:TROUT, SUSAN SHARON KLAW (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SHARON KLAW
Last Name:TROUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1235 OSOS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3619
Mailing Address - Country:US
Mailing Address - Phone:805-549-0888
Mailing Address - Fax:805-549-8463
Practice Address - Street 1:1235 OSOS ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3619
Practice Address - Country:US
Practice Address - Phone:805-549-0888
Practice Address - Fax:805-549-8463
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60949021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics