Provider Demographics
NPI:1568415503
Name:TREHARNE, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:TREHARNE
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 1:1340 TUSKAWILLA RD
Mailing Address - Street 2:SUITE 101-105
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5030
Mailing Address - Country:US
Mailing Address - Phone:407-699-1160
Mailing Address - Fax:407-699-7861
Practice Address - Street 1:1340 TUSKAWILLA RD
Practice Address - Street 2:SUITE 101-105
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5030
Practice Address - Country:US
Practice Address - Phone:407-699-1160
Practice Address - Fax:407-699-7861
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53556OtherBCBS
080095082OtherRAILROAD MEDICARE
FL046704900Medicaid
C89560Medicare UPIN
FL53556XMedicare PIN