Basic Information
| Provider Information | |||||||||
| NPI: | 1922737550 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAMMEL | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | ELIJAH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 19679 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627949679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175453518 | ||||||||
| FaxNumber: | 2175452711 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 N. 1ST ST. | ||||||||
| Address2: | SUITE D220 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627023753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175453518 | ||||||||
| FaxNumber: | 2175452711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2022 | ||||||||
| LastUpdateDate: | 06/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 125080692 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.