Individual
DR. TRENT LEE PROFFITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
502 ELM ST NE, ALBUQUERQUE, NM 87102-2512
(505) 841-1000
(505) 843-2592
Mailing address
502 ELM ST NE, ALBUQUERQUE, NM 87102-2512
(505) 841-1000
(505) 843-2956
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
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