Provider Demographics
NPI:1104931179
Name:TREVOR, EVERETT D (MD)
Entity type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:D
Last Name:TREVOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1145 WHISKEYTOWN CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0227
Mailing Address - Country:US
Mailing Address - Phone:530-246-4180
Mailing Address - Fax:530-242-6421
Practice Address - Street 1:1145 WHISKEYTOWN CT
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0227
Practice Address - Country:US
Practice Address - Phone:530-246-4180
Practice Address - Fax:530-242-6421
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2012-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG304360207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G304363Medicare PIN