Provider Demographics
NPI:1487749305
Name:TRENCH, JOHN L III (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:TRENCH
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4019
Mailing Address - Country:US
Mailing Address - Phone:812-232-0957
Mailing Address - Fax:812-242-1563
Practice Address - Street 1:1216 WABASH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3312
Practice Address - Country:US
Practice Address - Phone:812-232-0957
Practice Address - Fax:812-242-1563
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000711A213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100350020Medicaid
IN247830AMedicare PIN
INT95587Medicare UPIN
IN247830AMedicare ID - Type Unspecified