Provider Demographics
NPI:1811283930
Name:TROUT, ELIJAH SHAUN (DO)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:SHAUN
Last Name:TROUT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23107 ISTHMUS COVE CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6501
Mailing Address - Country:US
Mailing Address - Phone:806-831-1895
Mailing Address - Fax:
Practice Address - Street 1:23107 ISTHMUS COVE CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6501
Practice Address - Country:US
Practice Address - Phone:806-831-1895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010195602085R0202X
IADO-048672085R0202X
TXQ74912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology