Provider Demographics
NPI:1992951883
Name:TRUJILLO, MANUEL G JR (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:G
Last Name:TRUJILLO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 INDIAN WELLS DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-6625
Mailing Address - Country:US
Mailing Address - Phone:864-612-0045
Mailing Address - Fax:
Practice Address - Street 1:2755 S HIGHWAY 14 STE 2050
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4933
Practice Address - Country:US
Practice Address - Phone:864-849-9330
Practice Address - Fax:864-530-6990
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31158208200000X, 208600000X, 2086S0122X
SCLL31158208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC311585Medicaid
SCSCA8573365OtherMEDICARE PIN
SCSCA8577628OtherMEDICARE PIN