Provider Demographics
NPI:1780621094
Name:TROMBLEY, WANWISA YAMFANG (MD)
Entity type:Individual
Prefix:DR
First Name:WANWISA
Middle Name:YAMFANG
Last Name:TROMBLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:WANWISA
Other - Middle Name:YAMFANG
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9101
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9494
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-745-4336
Practice Address - Street 1:14856 PRESTON RD
Practice Address - Street 2:SUITE #100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-6822
Practice Address - Country:US
Practice Address - Phone:972-387-8900
Practice Address - Fax:972-661-9868
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI20496Medicare UPIN
TX610999Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER