Provider Demographics
NPI:1649374992
Name:TROTTER, MARVIN MARCUS (DPM)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:MARCUS
Last Name:TROTTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66156
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6156
Mailing Address - Country:US
Mailing Address - Phone:225-650-2000
Mailing Address - Fax:225-650-2099
Practice Address - Street 1:3140 FLORIDA STREET
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3757
Practice Address - Country:US
Practice Address - Phone:225-650-2000
Practice Address - Fax:225-650-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD099R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1143928Medicaid
LA1143928Medicaid
LAU76577Medicare UPIN