Provider Demographics
NPI:1710967559
Name:TRINITY, JOHN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:TRINITY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:RICHARD
Other - Last Name:TRINITY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2241 K AVE
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-6074
Mailing Address - Country:US
Mailing Address - Phone:712-623-5486
Mailing Address - Fax:712-623-5487
Practice Address - Street 1:2241 K AVE
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-6074
Practice Address - Country:US
Practice Address - Phone:712-623-5486
Practice Address - Fax:712-623-5487
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26992208600000X
NE18368208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA27084OtherBCBS
IA0270843Medicaid
IA0270843Medicaid
27084Medicare PIN