Provider Demographics
NPI:1699933192
Name:DAVID R. TREVARTHEN, M.D., P.C.
Entity type:Organization
Organization Name:DAVID R. TREVARTHEN, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:TREVARTHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-788-8675
Mailing Address - Street 1:799 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2700
Mailing Address - Country:US
Mailing Address - Phone:303-788-8675
Mailing Address - Fax:303-761-8031
Practice Address - Street 1:799 E HAMPDEN AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2700
Practice Address - Country:US
Practice Address - Phone:303-788-8675
Practice Address - Fax:303-761-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19508174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85921084Medicaid
CO85921084Medicaid