Provider Demographics
NPI:1508869603
Name:TREVINO, JOSE D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:D
Last Name:TREVINO
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 1:613 ELIZABETH ST
Mailing Address - Street 2:STE 805
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2232
Mailing Address - Country:US
Mailing Address - Phone:361-883-1744
Mailing Address - Fax:361-882-3920
Practice Address - Street 1:613 ELIZABETH ST
Practice Address - Street 2:STE 805
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2232
Practice Address - Country:US
Practice Address - Phone:361-883-1744
Practice Address - Fax:361-882-3920
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2013-09-30
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXF2074207LP2900X, 207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133638001Medicaid
TX0017DROtherBLUE CROSS/BLUE SHIELD
TX00NB35Medicare ID - Type Unspecified
TX133638001Medicaid
TX8F9592Medicare PIN