Individual
DR. PHYLLIS J TROTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AU. D./ CCC-A
Contact information
Practice address
1136 E GRANDE BLVD, TYLER, TX 75703-3982
(903) 592-5601
(903) 595-3304
Mailing address
1136 E GRANDE BLVD, TYLER, TX 75703-3982
(903) 592-5601
(903) 595-3304
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
3575
OK
231H00000X
Audiologist
Primary
80550
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
322324001
—
TX
05
—
54903
—
ND
01
—
75-2616977-009
TRICARE
TX
01
—
80859A
BCBS BLUE
TX
01
—
P01226413
MEDICARE RAIL ROAD
TX
Enumeration date
11/20/2006
Last updated
07/21/2022
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