Provider Demographics
NPI:1114913761
Name:TRENT, ROBERT GRINNELL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GRINNELL
Last Name:TRENT
Suffix:
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 1:3190 CHURN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2122
Mailing Address - Country:US
Mailing Address - Phone:530-223-2500
Mailing Address - Fax:530-226-1375
Practice Address - Street 1:3190 CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2122
Practice Address - Country:US
Practice Address - Phone:530-223-2500
Practice Address - Fax:530-226-1375
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86708207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G867080Medicaid
CA00G867080Medicaid
00G867080Medicare ID - Type Unspecified