Provider Demographics
NPI:1730204207
Name:TROUTMAN, WILBUR (MD)
Entity type:Individual
Prefix:
First Name:WILBUR
Middle Name:
Last Name:TROUTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 MORGAN LN # B
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4833
Mailing Address - Country:US
Mailing Address - Phone:310-372-9520
Mailing Address - Fax:
Practice Address - Street 1:3660 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2653
Practice Address - Country:US
Practice Address - Phone:310-631-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73397207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G733970OtherMEDI-CAL PROVIDER NUMBER