Provider Demographics
NPI:1285717116
Name:TREVINO, CARLOS F (MD, PC)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:F
Last Name:TREVINO
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 12TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3613
Mailing Address - Country:US
Mailing Address - Phone:406-488-2574
Mailing Address - Fax:406-488-5514
Practice Address - Street 1:181 12TH AVE SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3613
Practice Address - Country:US
Practice Address - Phone:406-488-2574
Practice Address - Fax:406-488-5514
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000091046OtherBLUE CROSS
MT000084878Medicare ID - Type Unspecified
H73061Medicare UPIN