Provider Demographics
NPI:1508617796
Name:SMITH, TREVOR JAMES
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:JAMES
Last Name:SMITH
Suffix:
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 1:1656 E BLUEFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-1345
Mailing Address - Country:US
Mailing Address - Phone:602-380-6210
Mailing Address - Fax:
Practice Address - Street 1:1300 N 12TH ST STE 605
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2850
Practice Address - Country:US
Practice Address - Phone:602-255-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program