Provider Demographics
NPI:1427227834
Name:EVERETT TREVOR, MD, INC
Entity Type:Organization
Organization Name:EVERETT TREVOR, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:TREVOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-246-4180
Mailing Address - Street 1:1145 WHISKEYTOWN CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0228
Mailing Address - Country:US
Mailing Address - Phone:530-246-4180
Mailing Address - Fax:530-242-6421
Practice Address - Street 1:1145 WHISKEYTOWN CT
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0227
Practice Address - Country:US
Practice Address - Phone:530-246-4180
Practice Address - Fax:530-242-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G304360207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G304360Medicaid
CAZZZ07405ZMedicare PIN
CA00G304360Medicaid
CA00G304360Medicare PIN