Provider Demographics
NPI:1679505721
Name:TREYVE, EDWARD LEON (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEON
Last Name:TREYVE
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 1:1801 1ST AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-636-4469
Mailing Address - Fax:360-425-4970
Practice Address - Street 1:1801 1ST AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-636-4469
Practice Address - Fax:360-425-4970
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015870207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1767409Medicaid
WA8863942Medicare PIN
WA1767409Medicaid