Provider Demographics
NPI:1437169281
Name:STATLER, TRENTON K (DPM)
Entity Type:Individual
Prefix:
First Name:TRENTON
Middle Name:K
Last Name:STATLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5494
Mailing Address - Country:US
Mailing Address - Phone:843-524-0232
Mailing Address - Fax:843-524-3323
Practice Address - Street 1:1084 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5494
Practice Address - Country:US
Practice Address - Phone:843-524-0232
Practice Address - Fax:843-524-3323
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC560213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD5602Medicaid
SC0169920001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUPMENT
480034304Medicare ID - Type UnspecifiedRAILROAD MEDICARE
SCU902562356Medicare ID - Type UnspecifiedMEDICARE
SCPD5602Medicaid