Provider Demographics
NPI:1386650745
Name:TREVINO, CHRIS T (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:T
Last Name:TREVINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTOPHER
Other - Middle Name:T
Other - Last Name:TREVINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:41229 HIGHWAY 941
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8206
Mailing Address - Country:US
Mailing Address - Phone:225-806-3397
Mailing Address - Fax:225-644-1423
Practice Address - Street 1:41229 HIGHWAY 941
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8206
Practice Address - Country:US
Practice Address - Phone:225-806-3397
Practice Address - Fax:225-644-1423
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0232552084P0800X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5A536OtherMEDICARE PTAN
LA1698270Medicaid
LA1698270Medicaid