Provider Demographics
NPI:1033282124
Name:KING, TRISHA MELAINE (DPM)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:MELAINE
Last Name:KING
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:MELANIE
Other - Last Name:TRAINOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:3702 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1320
Mailing Address - Country:US
Mailing Address - Phone:806-747-4467
Mailing Address - Fax:806-788-1708
Practice Address - Street 1:3702 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1320
Practice Address - Country:US
Practice Address - Phone:806-747-4467
Practice Address - Fax:806-788-1708
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1781213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192330210Medicaid
TX1923302Medicaid
TX192330208Medicaid
TX192330209Medicaid
TXP01571957OtherRAILROAD MEDICARE
TX279851YR1KMedicare PIN
TX1923302Medicaid
TX192330208Medicaid
TX192330210Medicaid