Basic Information
| Provider Information | |||||||||
| NPI: | 1609838887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TROTTA | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1195 GARNER FIELD RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788014820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302783086 | ||||||||
| FaxNumber: | 8302788873 | ||||||||
| Practice Location | |||||||||
| Address1: | 1195 GARNER FIELD RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788014820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302783086 | ||||||||
| FaxNumber: | 8302788873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 09/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA01261 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AM0700X | PA01261 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PA01261 | 01 | TX | PHYSICIAN ASSISTANT PERMI | OTHER |