Provider Demographics
NPI:1396730362
Name:LAW, TREVOR M (MD)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:M
Last Name:LAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12868
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-2868
Mailing Address - Country:US
Mailing Address - Phone:727-824-8357
Mailing Address - Fax:727-824-3132
Practice Address - Street 1:620 10TH STREET N.
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1407
Practice Address - Country:US
Practice Address - Phone:727-824-8243
Practice Address - Fax:727-824-8233
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME68288207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377970000Medicaid
FL27535XMedicare PIN
FLG09952Medicare UPIN