Provider Demographics
NPI:1033229448
Name:TIMSON, TRENT J (DPM)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:J
Last Name:TIMSON
Suffix:
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 1:316 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2301
Mailing Address - Country:US
Mailing Address - Phone:620-241-3313
Mailing Address - Fax:620-241-6967
Practice Address - Street 1:316 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2301
Practice Address - Country:US
Practice Address - Phone:620-241-3313
Practice Address - Fax:620-241-6967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200301213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5067668OtherAETNA
KS100317700AMedicaid
KS100317700AMedicaid
KS114023Medicare ID - Type UnspecifiedMEDICARE
KS431822463OtherEIN
KSU70793Medicare UPIN
KS100317700AMedicaid