Organization
MONTY V. TRIMBLE , MD, P.A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MONTY V TRIMBLE M.D. (OWNER/PHYSICIAN)
(817) 377-5223
Entity
Organization
Contact information
Practice address
3455 LOCKE AVE, SUITE 210, FORT WORTH, TX 76107-5719
(817) 377-5223
(817) 529-6205
Mailing address
3455 LOCKE AVE, SUITE 210, FORT WORTH, TX 76107-5719
(817) 377-5223
(817) 529-6205
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
L4150
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166931901
—
TX
01
—
L4150
STATES LICENSE
TX
Enumeration date
02/19/2008
Last updated
04/09/2015
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