Provider Demographics
NPI:1407372162
Name:TRIMBLE, JEFFERY CHARLES I
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:CHARLES
Last Name:TRIMBLE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 SKILIFT LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-2616
Mailing Address - Country:US
Mailing Address - Phone:757-870-9025
Mailing Address - Fax:804-272-3435
Practice Address - Street 1:1615 SKILIFT LANE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-2616
Practice Address - Country:US
Practice Address - Phone:757-870-9025
Practice Address - Fax:804-272-3435
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT60384784172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver