Provider Demographics
NPI:1881677821
Name:HOVENGA, TRENT L (MD)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:L
Last Name:HOVENGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 RUGELY CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5954
Mailing Address - Country:US
Mailing Address - Phone:719-475-7777
Mailing Address - Fax:719-694-3565
Practice Address - Street 1:110 RUGELY CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80906-5954
Practice Address - Country:US
Practice Address - Phone:719-475-7777
Practice Address - Fax:719-694-3565
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27788208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01277888Medicaid
G16741Medicare UPIN
CO01277888Medicaid