Provider Demographics
NPI:1780775791
Name:ESPIRITU, TROY DAVID (DPM)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:DAVID
Last Name:ESPIRITU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1013 CENTRE BROOK CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4573
Mailing Address - Country:US
Mailing Address - Phone:706-653-5501
Mailing Address - Fax:706-653-5504
Practice Address - Street 1:1013 CENTRE BROOK CT
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4573
Practice Address - Country:US
Practice Address - Phone:706-653-5501
Practice Address - Fax:706-653-5504
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000895213E00000X
AL236213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA895OtherSTATE I.D
GA699165OtherBCBS OF GA
AL60023560OtherBCBS OF ALA
GA00954269AMedicaid
GA304882OtherWELLCARE
GA0436482793002OtherEMPLOYER ID
GA304882OtherWELLCARE
GA699165OtherBCBS OF GA
GAU80055Medicare UPIN
GA00954269AMedicaid