Provider Demographics
NPI:1437119989
Name:MCDANIEL, TRENT WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:WESLEY
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 CONGRESS PKWY S
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-2813
Mailing Address - Country:US
Mailing Address - Phone:423-381-0152
Mailing Address - Fax:423-381-8063
Practice Address - Street 1:2037 CONGRESS PKWY S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-2813
Practice Address - Country:US
Practice Address - Phone:423-381-0152
Practice Address - Fax:423-381-8063
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00351072OtherRAIL ROAD MEDICARE
IL2368975OtherUNITED HEALTHCARE
IL036111703Medicaid
IL08232205OtherBLUE CROSS BLUE SHIELD
IL678197OtherHEALTHLINK
IL095778OtherHEALTH ALLIANCE
ILK09130Medicare ID - Type UnspecifiedFOR GROUP #803540
IL036111703Medicaid
IL678197OtherHEALTHLINK
ILH73740Medicare UPIN