Provider Demographics
NPI:1184867467
Name:CORREIA, TREVOR J (IDMT)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:J
Last Name:CORREIA
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80 BOX 17488
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0075
Mailing Address - Country:US
Mailing Address - Phone:0118198-961-9251
Mailing Address - Fax:
Practice Address - Street 1:PSC 80 BOX 17488
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96367-0075
Practice Address - Country:US
Practice Address - Phone:0118198-961-9251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians