Basic Information
| Provider Information | |||||||||
| NPI: | 1013976349 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TROST | ||||||||
| FirstName: | EVAN | ||||||||
| MiddleName: | SCOT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | IX | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7975 N HAYDEN RD | ||||||||
| Address2: | STE D354 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852583243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805341045 | ||||||||
| FaxNumber: | 4802149722 | ||||||||
| Practice Location | |||||||||
| Address1: | 8328 E. HARTFORD DR. | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802149720 | ||||||||
| FaxNumber: | 4802149722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 01/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 32075 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 875669 | 05 | AZ | MEDICAID |