Provider Demographics
NPI:1528528965
Name:TROTTER, JACOB WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:WAYNE
Last Name:TROTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4238
Mailing Address - Country:US
Mailing Address - Phone:702-281-3214
Mailing Address - Fax:215-662-7919
Practice Address - Street 1:1221 MADISON ST STE 1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3589
Practice Address - Country:US
Practice Address - Phone:206-215-6251
Practice Address - Fax:206-215-6150
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2024-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD.MD.615247252085R0001X
PAMD4797312085R0001X
PAMT2184872085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology