Individual
DR. TRENT LEE PROFFITT
Active
Individual
DR. TRENT LEE PROFFITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
L3442
TX
2086S0129X
Vascular Surgery Physician
L3442
TX
2086S0129X
Vascular Surgery Physician
Primary
MD2015-0422
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157817101
—
TX
01
—
8J3515
BLUE CROSS BLUE SHIELD
TX
Enumeration date
05/11/2006
Last updated
08/06/2015
Update your record
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