Provider Demographics
NPI:1538227046
Name:TROBAUGH, GENE BRYANT (MD FACC)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:BRYANT
Last Name:TROBAUGH
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 JEFFERSON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3649
Mailing Address - Country:US
Mailing Address - Phone:360-802-5021
Mailing Address - Fax:360-825-5265
Practice Address - Street 1:1427 JEFFERSON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3649
Practice Address - Country:US
Practice Address - Phone:360-802-5021
Practice Address - Fax:360-825-5265
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013271207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1107465Medicaid
WAGAB09256Medicare PIN
WA1107465Medicaid