Provider Demographics
NPI:1972571750
Name:DAVIS, TRENT W (MD)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:501 S SANTA FE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4189
Mailing Address - Country:US
Mailing Address - Phone:785-452-7269
Mailing Address - Fax:785-452-6008
Practice Address - Street 1:501 S SANTA FE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4189
Practice Address - Country:US
Practice Address - Phone:785-309-0012
Practice Address - Fax:785-309-0709
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04280082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100351530CMedicaid
KS100351530CMedicaid
KS100351530BMedicaid