Provider Demographics
NPI:1063580207
Name:STERENCHOCK, TRENT DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:DOUGLAS
Last Name:STERENCHOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:233 N HOUSTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8944
Mailing Address - Country:US
Mailing Address - Phone:784-352-7012
Mailing Address - Fax:478-293-1583
Practice Address - Street 1:233 N HOUSTON RD STE 100
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8944
Practice Address - Country:US
Practice Address - Phone:478-352-7020
Practice Address - Fax:478-293-1583
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056269208800000X
GA061968208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA705543780AMedicaid
GA705543780DMedicaid
GA705543780BMedicaid