Provider Demographics
NPI:1780872648
Name:WILLIAM T TRABULSI DPM PA
Entity type:Organization
Organization Name:WILLIAM T TRABULSI DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:TRABULSI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-406-4806
Mailing Address - Street 1:19013 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-9200
Mailing Address - Country:US
Mailing Address - Phone:813-406-4806
Mailing Address - Fax:813-406-4807
Practice Address - Street 1:19013 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-9200
Practice Address - Country:US
Practice Address - Phone:813-406-4806
Practice Address - Fax:813-406-4807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3124213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1003002759OtherMOBILE PHYSICIAN SERVICE, P.A.
FLDE7120OtherMEDICARE RAILROAD
FL1003002759OtherMOBILE PHYSICIAN SERVICE, P.A.
FLK9565Medicare PIN
FLV02170Medicare UPIN