Provider Demographics
NPI:1225392459
Name:SHULL, TREVOR W (MD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:W
Last Name:SHULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4451
Mailing Address - Fax:970-490-4199
Practice Address - Street 1:311 STEELE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206
Practice Address - Country:US
Practice Address - Phone:303-372-4010
Practice Address - Fax:303-372-4011
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2018-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.126673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine