Basic Information
| Provider Information | |||||||||
| NPI: | 1619267861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRUSS | ||||||||
| FirstName: | WILEY | ||||||||
| MiddleName: | DEWITT | ||||||||
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| Credential: | M.D., MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 513 BROOKWOOD BLVD | ||||||||
| Address2: | STE 401 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352096883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058700256 | ||||||||
| FaxNumber: | 2054230416 | ||||||||
| Practice Location | |||||||||
| Address1: | 513 BROOKWOOD BLVD | ||||||||
| Address2: | STE 401 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352096883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058700256 | ||||||||
| FaxNumber: | 2054230416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2011 | ||||||||
| LastUpdateDate: | 03/20/2018 | ||||||||
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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 | 207RG0100X | 32032 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 200952 | 05 | AL | MEDICAID |