Basic Information
| Provider Information | |||||||||
| NPI: | 1740220102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUJILLO | ||||||||
| FirstName: | DWAYNE | ||||||||
| MiddleName: | ERNEST | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 INDEPENDENCE DR. #700 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075693600 | ||||||||
| FaxNumber: | 9075693200 | ||||||||
| Practice Location | |||||||||
| Address1: | 9500 INDEPENDENCE DR. #700 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075693600 | ||||||||
| FaxNumber: | 9075693200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3582 | AK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.