Provider Demographics
NPI:1750358263
Name:TROUT, WILLIAM CLIFTON (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLIFTON
Last Name:TROUT
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 1:217 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3322
Mailing Address - Country:US
Mailing Address - Phone:814-333-9196
Mailing Address - Fax:814-333-9196
Practice Address - Street 1:217 NORTH ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3322
Practice Address - Country:US
Practice Address - Phone:814-333-9196
Practice Address - Fax:814-333-9196
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002086L213E00000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000790418Medicaid
T27670Medicare UPIN
PA056853Medicare PIN
PA000790418Medicaid
PA4352950002Medicare NSC