Provider Demographics
NPI:1194085811
Name:TRUST, PHYLLIS M (DO)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:M
Last Name:TRUST
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3694 STARRS CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9514
Mailing Address - Country:US
Mailing Address - Phone:330-702-1310
Mailing Address - Fax:330-702-3144
Practice Address - Street 1:3694 STARRS CENTRE DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9514
Practice Address - Country:US
Practice Address - Phone:330-702-1310
Practice Address - Fax:330-702-3144
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34008081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine