Provider Demographics
NPI:1992740260
Name:TRENTHAM, ORIN PAUL III (MD)
Entity type:Individual
Prefix:DR
First Name:ORIN
Middle Name:PAUL
Last Name:TRENTHAM
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 IMPALA DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-8293
Mailing Address - Country:US
Mailing Address - Phone:417-540-1036
Mailing Address - Fax:
Practice Address - Street 1:1808 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2724
Practice Address - Country:US
Practice Address - Phone:479-968-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-12463207R00000X
MO106911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100165470BMedicaid
OK100181910AMedicaid
MO207744806Medicaid
MO9296OtherANTHEM
110111900OtherRR MEDICARE
MO001013214Medicare PIN
MO207744806Medicaid