Provider Demographics
NPI:1831408319
Name:GEORGE S TROTTER MD PA
Entity type:Organization
Organization Name:GEORGE S TROTTER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SEDDING
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:904-356-3318
Mailing Address - Street 1:2023 MYRA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3714
Mailing Address - Country:US
Mailing Address - Phone:904-356-3318
Mailing Address - Fax:904-356-3259
Practice Address - Street 1:2023 MYRA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3714
Practice Address - Country:US
Practice Address - Phone:904-356-3318
Practice Address - Fax:904-356-3259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050457200Medicaid
FL16481Medicare PIN
FL050457200Medicaid